开胸恶性肿瘤切除术后多模式镇痛

Clinical study on multimodel of postoperative analgesia of thoractomy for malignant tumors excision

目的:研究多模式镇痛应用于开胸恶性肿瘤切除术后的有效性及安全性。方法:随机均分60例择期行开胸恶性肿瘤切除术患者于4组中。A组:单次静脉注射氟比洛芬酯组;B组:舒芬太尼电子镇痛泵静脉自控镇痛组;C组:地佐辛电子镇痛泵静脉自控镇痛组;D组:舒芬太尼静脉自控-靶控(PCA-TCI)镇痛组。记录4组患者手术结束后各时间点生命体征、动脉血气分析、Prince-Henry镇痛评分、Ramsay镇静评分、补救措施及不良反应。结果:D组Prince-Henry镇痛评分下降幅度较A、B、C组大,组间比较有统计学差异(P<0.05);D组患者Ramsay镇静评分下降幅度较A、B、C组大,组间比较有统计学差异(P<0.05);D组中无需疼痛补救性按压措施的患者较B、C组多,组间比较有统计学差异(P<0.05)。结论:开胸恶性肿瘤切除术后使用舒芬太尼PCA-TCI镇痛(镇痛血浆靶浓度0.12~0.14 ng/m L)有效性及安全性好,且可达到个体化镇痛。

Objective To evaluate the effectiveness and safety of muhimodal postoperative analgesia of thoracotomy for malignant tumor excision. Method Sixty patients undergoing thoracotomy for malignant tumor excision were recuited. They were randomized into four groups ： group A receiving single flurbiprofen axetil injection, group B using electronic analgesia pump for sufentanil PCIA, group C using electronic analgesia pump for dezocine PCIA and group D receiving sufentanil controlled by PCA-TCI system. Vital signs, artery lood gas analysis, PrinceHenry score, Ramsay score, remedial measure and untoward reactions were recorded. Results The falling down degree of Prince-Henry score of Group D was higher than those of Groups A, B and C （P 〈 0.05）. Reduction of Ramsay score of Group D was higher than those of Groups A, B and C （P 〈 0.05）. The number of the patients in Group D not undergoing Bolus remedial measure was larger than that of those in Groups B and C （P 〈 0.05）. Conclusion When referring to the effectiveness and safety of the models administrated the thoracotomy for malignant tumors excision, the analgesia model of PCA-TCI sufentanil （plasma target concentration ： 0. 12 - 0.14 ng/ mL） used in Group D is superior to other models used in Groups A, B and C. Moreover, individual analgesia can be reached by the PCA-TCI sufentanil model.