肺叶切除术后两种镇痛方法效果比较

Different effects of two analgesia methods after pulmonary lobectomy

目的：研究开胸肺叶切除术患者胸部硬膜外镇痛与静脉镇痛的效果及对术后肺部并发症的影响。方法：选择80例ASA I~Ⅱ级、开胸肺叶切除患者随机分为两组,A组麻醉方法为静吸复合麻醉,术后静脉芬太尼患者自控镇痛（PC IA）;B组全麻诱导前T5-6间隙硬膜外置管,2%利多卡因3 m l试验剂量,术后罗哌卡因及芬太尼硬膜外镇痛（PEA）。所有患者均记录气管导管及胸腔引流管拔除时间;术后第4,24,48 h静息及运动疼痛评分,镇静评分。观察两组术后肺部并发症（感染、肺不张）发生率。结果：B组患者气管导管拔除时间（0.7±0.2）h早于A组（2.1±0.4）h,P〈0.01;胸腔引流管拔除时间（2.7±0.6）d明显早于A组（4.3±0.7）d,P〈0.05。B组术后各时间点静息及运动疼痛评分均小于A组（P〈0.05）,而镇静评分两组无差异。术后B组肺部并发症发生率7.5%低于A组17.5%,P〈0.05,特别是术后肺部感染发生率两组有明显差异（2.5%与12.5%,P〈0.01）。结论：开胸肺叶切除手术硬膜外镇痛效果优于静脉自控镇痛,并可减少术后肺部并发症的发生。

Objective： To investigate analgesia effects and pulmonary complication incidence induced by two analgesia methods. Methods： In this study 80 patients scheduled for elective lobectomy were randomized to either PCIA fentanyl（Group A, n =40） or thoracic epidural analgesia with ropivacaine and fentanyl （Group B, n = 40）. Time to remove endotracheal tube and intrathoracic drain tube, analgesia score（including rest and movement） as well as sedation score at 4, 24, 48 h postoperatively were recorded. Incidence of pulmonary complication including atelectasis and pneumonia was also calculated. Results： In group B, it was earlier to remove endotracheal tube and intrathoracic drain tube than group A ; they were （0.7 ±0.2） h vs （2.1±0.4） h, P 〈 0.01. and （2.7± 0.6） d vs （4.3 ± 0.7 ） d, P 〈 0.05 respectively. Intensity of pain during the first two days postoperatively was significantly lower at rest or with coughing in group B, but there was no significant difference in sedation score between groups. Incidence of lung complication was lower in group B （7.5 % vs 17.5 %, P 〈 0.05 ）, especially with respect to pneumonia （ 2.5 % vs 12.5 %, P 〈 0.01 ）. Conclusion： Thoracic epidural analgesia was not only superior to PCIA inquality of analgesia for patients underwent lobectomy,but it also could reduce lung complication incidence.