关胸始硬膜外追加局麻药对自控镇痛的影响

The effect of supplementing local anesthetics epidurally at the beginning of thoracic closure on PCEA

目的 :探讨胸部手术关胸始硬膜外追加局麻药对术后硬膜外自控镇痛 (PCEA)的效果。方法 :对 6 8例择期肺、食道肿瘤根治术病人随机分为两组 ,实验组 :关胸始硬膜外追加 1.6 %利多卡因和 0 .2 %丁卡因或 0 .375 %布比卡因 4 6ml,2 0min后给吗啡 2mg加氟哌利多 2mg ,稀释至 10ml。对照组 :关胸始不用上述局麻药 ,2 0min后的给药同实验组。当两组病人术毕清醒拔气管导管时 ,再接二种浓度不同的布比卡因混合麻醉性镇痛药。实验组为 0 .12 5 %布比卡因加芬太尼 0 .3mg加氟哌利多 5mg。对照组为 0 .2 %布比卡因加实验组相同剂量的芬太尼和氟哌利多 ,锁定流速 2ml/h。镇痛效果评定 :参照WH0疼痛分级标准 ,以病人对疼痛主观感觉的口述评分法判断镇痛效果。结果 :实验组镇痛效果持续完善 ,明显优于对照组 (P <0 .0 1)。对照组术后 4 8小时内需辅助其它办法协同镇痛 ,疼痛才能缓解。结论 :关胸始硬膜外追用局麻药 ,镇痛持续完善。

Objective:To investigate effects of supplementing locai anesthetic sepidurally at the beginning of thoracic closure on PCEA .Methods:Sixty-eightpatients undergoing elective thoracic surgery were randomly divided into two groups.In test group, 1.6% lidocaine +0.2% dicaine or 0.375% bupivacaine 4～6ml were supplemented epidurally at the beginning of thoracic closure, twenty minutes latermorphine 2mg +droperidol 2mg in 10ml saline were given.In control group,localanes thestics above weren't supplemented .twenty minutes later the same dose drugs astest group were given.After postoperative recovery and extubation. two group patients received different concentrations bupivacaine combined with narcotic analgesics at arate of 2ml/.h, which were 0.125% bupivacaine +fentanyl 0.3mg + droperidol 5mg intest group and 0.2% bupivacaine combined with the same dose fentanyl and droperidol in control group. Analgesia effect was assessed with who pain geades after operation. Results:Analgesia effect of test group was continuous and perfect and significantly more superior than that of control group (p<0.01) In control group, pain wasn't relieved until another analgesia method was assisted within postoperative 48hours. Conclusions:Analgesia effect will be continuous and perfect, if local anestheticswere supplemented epidurally at the beginning of thoracic closure.