椎旁间隙置管用于肺癌术后镇痛18例分析

An Analysis of Para-vertebral Space Catheterization on Postoperative Analgesia for 18 Cases with Lung Cancer after Thoracotomy

[目的]探讨椎旁间隙置管用于肺癌术后镇痛的临床疗效。[方法]将54例全身麻醉开胸肺癌患者随机平均分为三组。A组:肌注镇痛法,即术后疼痛时每次肌注哌替定1mg/kg;B组:自控硬膜外镇痛,药物配方为吗啡8mg+0.125%布比卡因100ml,注入速度为2ml/h;C组:经壁层胸膜穿孔脊柱旁间隙置管单侧多根肋间神经连续阻滞术镇痛,关胸前直视下置管,接微量泵(ATRAVEOI6200)以4～6ml/h持续泵入0.15%利多卡因。比较三组肺癌患者术后6h、12h、24h及48h切口疼痛程度、镇痛副作用及肺部并发症的发生情况等。[结果]A组术后6h、12h、24h及48h的镇痛效果明显较B组和C组相同时间点差(P<0.05)。B组和C组肺癌患者术后6h、12h、24h及48h镇痛效果均满意,两组间无显著性差异(P>0.05)。C组镇痛副作用及并发症较A组和B组明显减少(P<0.05)。[结论]脊柱旁间隙置管用于肺癌术后镇痛简单、安全易行、效果良好。

[Purpose] To explore the clinical effects of postoperative analgesia by means of para-vertebral space catheterization（PVSC） for lung cancer after operation. [Methods] Fifty-four cases with lung cancer scheduled for thoracic surgery under general anesthesia were randomized equally into three groups. Group A： intramuscular injection group, namely the patients who felt pain were administered intramuscalarig pethidine with 1mg/kg eve17 time after operation; Group B： patient-controlled epidural analgesia（PCEA） group, received morphine 8mg＋0.125% bupivacaine 100ml continuous infusion with 2ml/h after operation; Group C： continuous block several intercostal nerves hy means of PVSC at the time of thoracotomy closure, received 0.15% lidocaine continuous infusion with 4-6ml/h by minim pump（ATRAVEOI 6200）. Incision pain degree at 6h, 12h, 24h and 48h after operation, and side effects of postoperative analgesia, incidence of pulmonary complicating diseases among the three groups were compared. [Results] The scores of analgesic scale of group B and group C at 6h, 12h, 24h and 48h after operation were significantly superior than that in group A respectively（P〈0.05）, but there was no significantly difference between group B and group C（P〉0.05）. The side effects and pulmonary complications in group C were significantly lower than those in group A and group C （P〈0.05）. [Conclusion] The technique of PVSC is easy performing, safe and effective to relieve pain for postoperative lung cancer.