开胸围术期应用多模式镇痛对术后镇痛及镇静效果的影响

Effects of open chest operation stage of application of multimodal analgesia for postoperative analgesia and sedation effect

目的探讨开胸围术期应用多模式镇痛对术后镇痛及镇静效果的影响。方法将60例拟行左侧开胸食管癌根治术患者随机分为两组,各30例。两组均给予咪唑安定、舒芬太尼、维库溴铵和异丙酚麻醉诱导,2%～3%七氟烷及舒芬太尼维持麻醉。对照组采用术后舒芬太尼自控镇痛（PCIA）,观察组在麻醉诱导前采用帕瑞昔布钠静脉滴注＋术中左旋布比卡因肋间神经阻滞＋术后帕瑞昔布钠肌内注射及舒芬太尼PCIA多模式镇痛。观察两组患者术后48 h内各时间点视觉模拟疼痛评分法（VAS）评分及Ramsay镇静评分情况。结果观察组术后2 h、6 h、12 h、24 h、48 h疼痛VAS评分均低于对照组（P〈0.01）;两组术后48 h内各时间点Ramsay镇静评分比较差异均无统计学意义（P〉0.05）。结论开胸围术期应用多模式镇痛可缓解术后疼痛,减少副作用,提高患者舒适度,而对术后镇静无明显影响。

Objective To study the effects of open chest operation stage of application of multimodal analgesia for postoperative analgesia and sedation effect. Methods Sixty cases of left open radical resection were randomly divided into two groups,each group contains 30 cases of thoracic esophageal carcinoma. Two groups of midazolam sufentanil,vecuronium bromide and 0,propofol anesthesia induction,2% ～ 3% seven halothane and sufentanil anesthesia maintenance. The control group took the postoperative sufentanil analgesia（ PCIA） and the observation group before anesthesia induction using Rui Celebrex sodium intravenous parecoxib sodium injection ＋ and PCIA multi mode of analgesia of sufentanil l than ropivacaine intercostals nerve block and postoperative. The postoperative 48 h at each time point in the VAS score,Ramsay sedation score. Results In the observation group,after 2 h,6 h,12 h,24 h,48 h VAS pain score lower than those of the control group（ P〈0. 01）. The two groups were not statistically significant after operation each time point 48 h Ramsay sedation score difference（ P〉0. 05）. Conclusion The multimodal analgesia can relieve postoperative pain,reduce the side effects of application of Rui Celebrex sodium intravenous induction before and after operation conclusion chest operative application after anesthesia and improve the comfort degree of patients. No significant effect on postoperative sedation.