胸部手术后硬膜外自控镇痛对术后肺部感染影响的研究

Effort of postoperative controlled epidural analgesia on postoperative pneumonia in patients underwent thoracic surgery

目的探讨胸部(胸壁、胸内)手术后硬膜外镇痛的必要性和优越性。方法全组48例,随机分为两组,每组24例。A组为实验组,B组为对照组。全部病例均选择气管内插管全麻加胸段硬膜外阻滞方式,A组手术结束时采用负荷剂量+持续输注+病人自控模式(LCP),B组术后病人感疼痛时单次肌注哌替啶50 mg。结果经统计学处理,术前两组各项生命指征无显著性差异(P>0.05);A组手术前后六项指征的改变无显著性差异(P>0.05);B组手术前后R、V、FEV1.0、SpO2、HR的比较,差异显著或非常显著(P<0.05或<0.01);手术前后MAP比较,无显著差异(P>0.05)。两组舒适状态及镇痛效果比较,均有非常显著差异(P<0.01);两组术后肺部感染率相比,差异有显著性(P<0.05)。结论胸部手术后病人PCEA优于临时注射哌替啶镇痛,能有效预防肺部感染等并发症。

Objective To study the necessity and superiority of postoperative controlled epidural analgesia （PCEA） in the patients underwent thoracic surgery. Methods Forty-eight patients were divided into treatment group and control group randomly. All of them were given the combination of general and thoracic epidural anesthesia. Treatment group were adopted LCP after operation. Control group were injected muscle pethidine 50 nag when they felt painful. Results there was no significant difference between two groups on the preoperative vital signs （ P 〉0.05）. there was no significant difference of the six vital signs before and after the operation in treatment group, while there was significant difference of R. V. FEV1.0 SpO2 HR before and after the operation in control group （ P 〈0. 01 or 〈0. 05）. And the comfortable,analgesia effect also had significant difference between two groups （ P 〈0.01）. The postoperative pneumonia rate had obvious difference between the two groups（ P 〈0.05）. Conclusion The PCEA was better than temporarily injecting muscle pethidine in the patient underwent thoracic surgery, it can prevent pneumonia and some other complications effectively.