自控硬膜外镇痛对食管癌术后肺部感染的影响

Post-thoracotomy Pulmonary Infection Influenced by Patient-controlled Epidural Analgesia after Thoracic Surgery of Esophagus Carcinoma

目的研究食管癌术后患者自控硬膜外镇痛(PCEA),对开胸手术后肺部感染(PTPI)的影响。方法两组患者中,一组175例采用PCEA镇痛(PCEA组),另一组153例常规用镇痛剂肌内注射镇痛(IM组),观察两组的镇痛效果,比较患者术后咳嗽排痰及PTPI发病情况。结果PCEA组VAS评分明显低于IM组(P<0.01);PCEA组患者术后咳嗽排痰良好者126例(72.00%)、较好者42例(24.00%)、不良者7例(4.00%),而IM组分别为61例(39.87%)、63例(41.18%)、29例(18.95%)(P<0.01);PCEA组有26例(14.86%)发生PTPI,IM组有38例(24.84%)(P<0.01)。结论PCEA是食管癌开胸手术后良好的镇痛方法,能够促进患者术后咳嗽排痰,能有效地降低PTPI的发病率,因此PCEA是预防PTPI的理想方法。

OBJECTIVE To evaluate the post-thoracotomy pulmonary infection （PTPI） influenced by patientcontrolled epidural analgesia（PCEA） after thoracic surgery of esophagus carcinoma. METHODS There were two patient groups. One included 175 cases with PCEA after thoracic surgery （PCEA group）. The other was with 153 cases after intramuscular analgesia （IM group）. We observed the healing effect of analgesia, comparison study on the coughing and PTPI after thoracic surgery of esophagus carcinoma. RESULTS The score of visual analog scale （VAS） in the PCEA group was lower than that in the IM group （P〈0.01）. In the PCEA group there were 126 （72.00%） cases with nice coughing, 42 （24. 00%） cases with better coughing, and 7 （4. 00%） cases with ineffective coughing. That in the IM group was 61 （39.87%）, 63 （41.18%）, and 29 （18. 95%）, respectively （P〈0.01）. There were 26 （14.86 % ） cases suffered from PTPI in the PCEA group. The IM group there were 38 （24. 84%） cases （P 〈 0. 01）. CONCLUSIONS PCEA is a good analgesic method after thoracic surgery of esophagus carcinoma. It can promote patients to cough and reduce PTPI, therefore PCEA is a good method for preventing PTPI.