开胸手术后伤口持续输注局麻药和PCIA的镇痛效果

Comparison of postoperative analgesic effects of continuous incision infusion and PCIA regimen after thoracotomy

目的比较开胸手术后伤口持续输注局麻药和PCIA的镇痛效果。方法择期开胸非心脏手术患者60例,ASAⅠ或Ⅱ级,随机均分为两组:伤口持续输注局麻药镇痛组(A组)和PCIA组(B组)。A组患者缝皮前在切口皮下处放置镇痛泵导管,继之通过导管快速给予0.5%罗哌卡因5ml,术毕48h内以2ml/h持续输注0.5%罗哌卡因。B组患者手术结束前30min缓慢静注舒芬太尼3μg,术毕接PCA泵以2ml/h(3μg/kg舒芬太尼配置成100ml)持续泵注。分别记录患者术后2、8、12、24、36、48h安静和活动时VAS评分、Ramsay镇静评分、术后需哌替啶镇痛例数、不良反应、住院时间及总体满意率等。结果两组患者术后不同时点安静时和活动时VAS评分差异无统计学意义。与A组比较,术后不同时点A组Ramsay镇静评分明显升高(P<0.05)。术后A组无一例患者发生不良反应,明显低于B组嗜睡26例(87%)、头晕11例(37%)(P<0.05)、呼吸抑制2例(6%)。A组满意率29例(97%),B组25例(83%),患者术后需哌替啶镇痛A组8例(26.7%),B组7例(23.3%),两组差异均无统计学意义。结论伤口持续输注局麻药镇痛和PCIA具有同样的镇痛效果,但伤口持续输注局麻药镇痛不良反应发生率低。

Objective To compare the postoperative analgesic effects of continuous incision infusion and intravenous PCA regimenafter thoracotomy.Methods Sixty patients scheduled for selective thoracotomy surgery were randomly divided into continuous incision infusion group（group A）and PCIA analgesia group（group B）（n=30in each group）.Patients in group A were inserted local anesthetic infiltrating catheter subcutaneously before incision suture.They received a bolus of 5 ml of0.5%ropivacaine followed by 2ml/h 0.5% ropivacaine for 48 hours.In group B,3μg sufentanil were injected intravenously before the end of surgery followed by the intravenous PCA regimen of 2ml/h sufentanil（3μg/kg sufentanil diluted to 100ml）.Visual analogue scores（VAS）of pain at rest and during activity,Ramsay scores,opioid consumptions,adverse effects,hospital stays and overall satisfaction at 2,8,12,24,36,48 h after the surgery were all recorded respectively.Results Compared with group B,patients in group A showed no significant difference in the VAS scores at rest or during activity,but the Ramsay scores showed significant difference（P〈0.05）.Less drowsiness and dizziness were observed in group A than group B（P〈0.05）.However,there were no significant differences in respiratory depression,overall satisfaction rate,supplement postoperative opoids consumptionbetween the two groups.Conclusion Postoperative continuous incision infusion has comparable analgesic effect but less adverse effects as compared to intravenous PCA regimen.