静脉和硬膜外自控镇痛对肺叶切除术后肺功能的影响

A prospective study of the effect of intravenous PCA and epidural PCA on postoperative pulmonary function after lobectomy

目的 比较静脉与硬膜外病人自控镇痛 (PCIA与PCEA)对肺叶切除术后肺功能的影响。方法 44例择期行单肺叶切除病人 ,随机分成PCIA组和PCEA组。分别于术前、术后 2 4、48h用脉冲振荡肺功能测定仪 (IOS)测定肺功能。结果 PCEA组与PCIA组术前肺功能无统计学差异 ;术后 2 4h两组与术前比较用力肺活量 (FVC)、1秒用力呼气量 (FVE1 )降幅较大 (P <0 0 5) ,呼吸总阻抗 (Zrs)、共振频率(Fres)、35Hz时呼吸阻力 (R35)、5Hz时呼吸电阻 (X5)升高显著 (P <0 0 5) ;术后 48h两组FVC、FEV1 、Zrs、Fres、R35、X5较术后 2 4h有所恢复 ,但PCEA组恢复更好 (P <0 0 5)。结论 胸科手术后用PCEA、PCIA均能获得较好的镇痛效果 。

Objective: To compare the effect of controlled intravenous analgesia (PCIA) and controlled epidural analgesia (PCEA) on postoperative pulmonary function after lobectomy. Methods: 44 patients undergoing elective lobectomy were randomly divided into PCIA group and PCEA group. Pulmonary function was measured before operation and at 24 hour and 48 hour after operation using impulse oscillometry (IOS). Results: Preoperative pulmonary tests showed that there were no remarkable differences between these 2 groups. The postoperative forced vital capacity (FVC) and forced expiratory volume in one second (FVE 1) decreased significantly at 24 hour when compared with preoperative results (P<0.05). Total pulmonary impedance (Zrs), resonance frequency (Fres), resistance to 35 hertz (R35) and reactance to 5 hertz (X5) improved significantly at 24 hour when compared with preoperative results (P<0.05). Then FVC, FVE 1, Zrs, Fres, R35 and X5 were improved from 48 hour after operation, but the recovery of these parameters in group PCEA were much more rapidly than that in group PCIA (P<0.05). Conclusion: Both PCIA and PCEA provide excellent analgesia after thoracic operation, but PCEA can effect a rapidly improved pulmonary function in the early stage following lobectomy.