一次性术后局部麻醉镇痛系统与静脉自控镇痛泵对常规开胸术后镇痛效果和安全性的比较

Comparison between the disposable postoperative local analgesia system and patient-controlled intravenous analgesia pump system in the analgesic efficacy and safety of conventional thoracotomy

目的研究一次性术后局部麻醉镇痛系统与静脉自控镇痛泵对常规开胸术后镇痛效果和安全性。方法将2013年6月至2014年6月在解放军第二炮兵总医院胸外科行常规开胸手术的80例患者纳入研究,经患者知情同意,签署知情同意书后运用随机数字表法分为局部麻醉镇痛系统组(试验组)与静脉自控镇痛泵组(对照组),每组40例。比较2组患者术后镇痛效果(疼痛视觉模拟(VAS)评分及Prince-Henry评分]、哌替啶累积用量、不良反应发生率。研究方案经医院伦理委员会讨论并通过。结果 (1)疼痛程度:术后12、24、48 h时,试验组患者的VAS评分(3.82±0.64,2.66±0.45,1.89±0.24)与对照组(3.71±0.77,2.74±0.55,1.94±0.51)差异无统计学意义(P>0.05);Prince-Henry评分(2.39±0.34,1.48±0.18,0.92±0.11)低于对照组(3.14±0.42,2.74±0.33,1.58±0.21),差异有统计学意义(P<0.05);(2)哌替啶累积使用剂量:试验组的哌替啶累积使用剂量少于对照组;(3)试验组患者术后肺不张、呼吸衰竭、恶心、呕吐、眩晕、嗜睡的发生率低于对照组患者。结论相比静脉自控镇痛泵,一次性术后局部麻醉镇痛系统能够取得更为理想的动态镇痛效果,减少阿片类药物的使用剂量以及不良反应的发生率,是更为安全有效的镇痛方法。

Objective To study the analgesic efficacy and safety of the disposable postoperative local analgesia system and patient-controlled intravenous analgesia pump system following conventional thoracotomy. Methods Eighty patients who received conventional thoracotomy in our hospital from June,2013 to June,2014 were enrolled for the study. The patients were randomly divided into the experimental group（ the disposable postoperative local analgesia system group） and the control group（ the patient-controlled intravenous analgesia pump system group）,each consisting of 40 patents. Postoperative analgesic efficacy（ visual analogue scores and Prince-Henry scores）,pethidine cumulative dosages and the incidence of adverse drug reactions were compared between the 2 groups.Results（ 1） Severity of pain： there was no difference in the VAS scores at h 12,24 and 48 after surgery,when comparisons were made between the 2 groups. However,the Prince-Henry scores of the experimental group（ 3. 82 ± 0. 64,2. 66 ± 0. 45,1. 89 ± 0. 24）were lower than those of the control group（ 3. 71 ± 0. 77,2. 74 ± 0. 55,1. 94 ± 0. 51）.（ 2） The cumulative dosages of pethidine： the cumulative dosage of the experimental group（ 2. 39 ± 0. 34,1. 48 ± 0. 18,0. 92 ± 0. 11） was lower than that of the control group（ 3. 14 ±0. 42,2. 74 ± 0. 33,1. 58 ± 0. 21）,there were statistical difference ushen comparisons were made between them（ P〈0. 05）.（ 3）Rates of atelectasis and respiratory failure,nausea,vomiting,dizziness and drowsiness of the experimental group were lower than those of the control group. Conclusion As compared with the patient-controlled intravenous analgesia pump,the disposable postoperative local analgesia system could achieve more ideal dynamic analgesic effects,reduce the dosage of opioid drugs and the rate of adverse drug reactions. More importantly,it was a safer and more effective analgesic method.