胸腔镜手术围术期多模式镇痛的临床研究

Multiple-model pain control method for postoperative pain relief after thoracoscope surgery

目的评价胸腔镜手术患者围术期应用氟比洛芬酯复合舒芬太尼静脉镇痛联合肋间神经阻滞的多模式镇痛效果和不良反应。方法 40例胸腔镜手术病人随机分成多模式组(A组)和传统组(B组),每组各20例。A组于麻醉诱导前连接镇痛泵行PCIA,术中持续输注2ml/h,并于切皮前进行一次罗哌卡因肋间神经阻滞;B组于术毕连接镇痛泵行PCIA。观察两组的术后镇痛效果和不良反应。结果与B组比较,A组术后48h内各时点静止及咳嗽状态时的VAS评分明显下降(P<0.05);A组48h舒芬太尼消耗量、PCA总按压次数及总有效按压次数分别为(105.13±1.78)μg、(5.35±2.06)和(3.82±2.17),均较B组的(120.45±1.34)μg、(12.39±2.25)和(9.67±1.83)明显下降,差异有统计学意义(P<0.05);A组恶心呕吐发生率亦较B组低(P<0.05)。结论胸腔镜手术实行围术期多模式镇痛的效果优于传统术后静脉镇痛方法,其不良反应发生率亦较低。

Objective To evaluate the analgesics effects and side effects of multiple-model pain control method for postoperative pain relief after thoracoscope surgery. Methods 40 patients undergoing thoracoscope surgery were randomly divided into 2 groups, namely multiple-model group （group A, n=20） and traditional treatment group （group B, n=20）. Patients in group A received Sulfentanyl for postoperative patient-controlled intravenous analgesia （PCIA） before anesthesia induction and were infused with Sulfentanyl continuously during operation. In addition,they were treated with preincisional ropivacaine for intercostal nerve block. Patients in group B received Sulfentanyl for PCIA after operation. Both groups received intravenous Sulfentanyl（10 μg） plus Flurbiprofen axetil（50 mg）, which were given to group A before anesthesia induction,while given to group B after operation. Results The VAS score in resting or active state, the dosage of Sulfentanyl,the total and valid number of pressing of PCIA pump in group A were significantly lower than those in group B（P0.05）. The incidences of nausea and vomiting in group A after operation were less than that in group B （P0.05）. Conclusion Multiple-model pain control method for postoperative pain relief after thoracoscope surgery has a better analgesic effect and lower incidence of side effects than traditional intravenous analgesia.