胸膜外间隙注射丁哌卡因用于胸科术后镇痛的可行性

Feasibility of application of extrapleural bupivacaine to postoperative analgesa of thoracic surgery

目的 探讨胸膜外间隙注入丁哌卡因用于胸科手术后镇痛的方法及可行性。方法 选择４０例行胸科手术的病人４０ 例，ＡＳＡ Ⅰ～Ⅱ级，随机分成两组。于关胸前，在切口后端上下两肋的壁层胸膜与肋骨肋间内肌之间行钝性分离，形成一横口袋状胸膜外间隙，留置导管以术后注入局麻药。术后Ｉ组病人首先注入负荷剂量０．５％ 丁哌卡因５ｍ ｌ，然后用ＰＣＡ 泵持续输注０．２５％ ～０．３７５％丁哌卡因２ｍ ｌ·ｈ－ １ ，每次ＰＣＡ的剂量３～５ｍ ｌ，锁定时间６０ 分钟；Ⅱ组病人每隔４～６ 小时直接推注０．５％ 丁哌卡因５ｍ ｌ。在术后镇痛的不同时点分别监测ＭＡＰ、ＨＲ、ＳｐＯ２ 、ＥＣＧ，采用视觉模拟评分法（ＶＡＳ）评分，以评价镇痛效果，记录整个镇痛过程并发症的发生率。结果 两组均可产生良好的镇痛效果，且Ｉ组的ＶＡＳ评分低于Ⅱ组（Ｐ＜ ０．０５）在整个镇痛过程中，两组病人的ＭＡＰ、ＨＲ、ＳｐＯ２ 及ＥＣＧ无明显变化（Ｐ＞ ０．０５），两组病人术后均无明显恶心、呕吐，咳嗽排痰良好，未发生肺不张等肺部并发症。结论 胸膜外间隙注入丁哌卡因用于开胸术后镇痛是安全有效的，采用ＰＣＡ方法用药更为有效。

Objective To evaluate the efficacy of extrapleural bupivacaine for postoperative analgesia of thoracic surgery.Methods Forty adult patients , ASA grade Ⅰ Ⅱ, undergoing thoracic surgery, were randomly divided into two groups: group Ⅰ and Ⅱ. Before the closure of the incision, an extrapleural space was made by blunt separation of the parietal pleura from the internal intercostal muscle posterior to the incision,where a catheter was placed to inject bupivacaine through. Following the end of surgery, the loading dose of 5% bupivacaine 5ml was given extrapleurally, then 0.25% 0.375% bupivacaine was infused continuously at 2 ml·h -1 using a PCA pump with the PCA/bolus dose of 3 5ml and lockout time of 60 min in group I; 0.5% bupivacaine was administered at a bolus dose of 5 ml at a interval of 4 6h in group Ⅱ. MAP,HR ,SpO 2,ECG, and score of visual analog scale (VAS) were measured at various postoperative times. Results The postoperative analgesia was good in both groups, but the score of VAS was lower in group I than that in group Ⅱ (P< 0.05 ), MAP,HR,SpO 2, and ECG remained unchanged significantly during whole postoperative procedures (P>0.05), with bringing smoothly up the phlegm on coughing, without the occurrence of postoperative nausea and vomiting and pulmonary complications. Conclusion The extrapleural bupivacaine can be applied effectively and safely to postoperative analgesia of thoracic surgery ,which is more effective with PCA method.