硬膜外持续注入吗啡用于开胸手术后镇痛的研究

Effects of continuous constant epidural infusion of morphine for postoperative analgesia after thoracic surgery

目的：探讨硬膜外持续恒速注入吗啡镇痛技术（ｃｏｎｔｉｎｕｏｕｓ ｃｏｎｓｔａｎｔ ｅｐｉｄｕｒａｌ ａｎａｌｇｅｓｉａ ＣＣＥＡ）用于开胸手术后镇痛的效果及安全性。方法：１００例ＡＳＡ１－３级开胸肿瘤手术病人随机分为ＣＣＥＡ组和肌注吗啡镇痛组（ＩＭ组）。记录术后４、１２、２４、３６、４８小时两组病人镇痛、镇静评分及副作用发生情况，持续监测血压、心率、呼吸频率、脉搏氧饱和度、血气等体征，并于术后７２小时对两组病人进行镇痛满意度调查。结果：ＣＣＥＡ组病人镇静评分、病人满意度评分显著高于ＩＭ组，镇痛评分显著低于 ＩＭ组（Ｐ＜ ０.０１）。 ＩＭ组病人 ＨＲ、 ＲＲ显著增高， ＳｐＯ_２降低（ Ｐ＜０.０５）。结论：开胸手术后应用 ＣＣＥＡ技术，镇痛完全，安全，并能改善呼吸功能。

Objective: To evaluate the efficacy and safety of continuous constant epidural infusion morphine combined with 0.125% Bupivcaine for postoperative analgesia after thoracic surgery. Method: One hundred patients scheduled for thoracic surgery under general anesthesia were randomly allocated to one of both groups respectively: CCEA group (n = 50) and intramuscular analgesia group (IM group n = 50). Pain scores .sedation scores and patients satisfaction scores toward analgesia were recorded, and HR, MAP, RR, SpO_2, Blood gas analysis were monitored in two groups after 4, 12, 24, 36, 48 hour of operation. Results: In CCEA group the sedation scores, patients satisfaction scores were significantly higher but pain scores were markedly lower than those in group IM(P<0.01). HR, RR in group IM increased significantly, SpO_2 was markedly decreased (P < 0.05). Conclusion: After thoracic surgery CCEA is a safe and effective analgesia method, also can improve respirative function.