剖胸手术硬膜外镇痛的临床治疗研究

Effort of postoperative controlled epidural analgesia in patients underwent thoracic surgery

目的探讨剖胸手术后硬膜外镇痛的必要性和优越性。方法取本院2006年11月至2009年11月间收治的剖胸手术患者24例,随机分为两组,每组12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+患者自控模式(LCP),B组术后患者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、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)。结论剖胸手术后患者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 anal- gesia （PCEA） in the patients underwent thoracic surgery. Methods From Nov. 2006 to Nov. 2009, 24 pa- tients were divided into treatment group and control group randomly. All of them were given the combination of general and thoracic epidura] anesthesia. Treatment group were adopted LCP after operation. Control group were injected muscle pethidine 50 mg 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 ,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. O1 ）. The postoperative pneumonia rate had obvious differ- ence 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.