肺癌术后硬膜外与静脉自控镇痛比较的临床观察

A comparison of patient controlled epidural analgesia (PCEA) and intravenous analgesia (PCIA) for postoperative lung cancer

目的 比较肺癌术后硬膜外自控镇痛 (PCEA)及静脉自控镇痛 (PCIA)的效果和并发症。方法 70例病人(ASAⅡ -Ⅲ级 )随机分成两组。A组 (n =35 )PCEA选用 0 .0 1%吗啡 +0 .15 %布比卡因。B组PCIA选用 0 .0 5 %吗啡 +0 .0 1%氟哌利多。均为持续注速 2ml/h单次PCA剂量 1ml锁定时间 2 0分钟模式。观察术后镇痛评分 ,镇痛总体满意度 ,镇静评分 ,对呼吸的影响及并发症。结果 综合镇痛质量PCEA组高于PCIA组 (P <0 .0 5 ) :PCEA组病人呼吸平稳、分钟通气量 (MV)和脉搏血氧饱和度 (SPO2 )变化不明显 ,而PCIA组MV和SPO2下降显著 ,氧疗后恢复正常水平 ,并发症 :恶心、呕吐、瘙痒、嗜睡的发生率PCIA组高于PCEA组 (P <0 .0 5 )。结论 肺癌术后应用PCEA镇痛效果满意 ,改善术后呼吸功能 ,提高术后康复质量 ,更适于开胸手术的术后镇痛。

Objective To compare the efficacy and complication of controlled epidural analgesia (PCEA)and intravenous analgesia (PCIA) for postoperative of lung cancer. Methods The patients(ASAⅡ-Ⅲ stage) were randomly divided into two groups, in PCEA(A) group,(n=35),patient received 0.01% morphine,0.15% babivacaine; In PCIA (B) group, 0.05% Morphine + 0.01% Babivacaine. In both groups, we observed the postoperative analgesia grade, the total analgesia satisfaction, sedation grade, efficiency of breath and complication. Results The effect in PCEA group was better than that PCIA group (P<0.05). In PCEA group,the patients breathed rhythmically and no changes of MV and Spo2 were observed.In PCIA group,the level of MV and SPO2 decreased obviously.It recovered to normal after oxygen-treatment.The complications of sickness, vomiting, nausea, itch and sleepy were higher in PCIA group than that in PCEA group (P<0.05). Conclusion The efficiency of PCEA in lung cancer postoperation is satisfactory.It can improve respiratory function and recovery quality of postoperation,which is more suitable for post-thoracotomy analgesia.