胸膜腔注射罗哌卡因复合舒芬太尼静脉镇痛在胸腔镜肺部手术后镇痛效果的观察

Postoperative analgesic effect of plural injection of ropivacaine combined with sufentanil in thoracoscopic lung surgery

目的观察胸膜腔注射罗哌卡因复合舒芬太尼静脉镇痛在胸腔镜肺部手术后的镇痛效果。方法选择择期行胸腔镜肺部手术ASA I^III级的患者30例,采用信封法将患者分为A组和B组,每组各15例,关胸前两组患者均由手术医生直视下在胸膜腔放置2条导管:1条胸腔闭式引流管,1条细导管(硬膜外导管)。两组患者手术结束均常规给予静脉自控镇痛泵。手术结束拔除气管导管后送术后恢复室,待患者完全清醒,能配合评估VAS时,A组通过留置的硬膜外导管往胸膜腔内注射0.75%罗哌卡因20ml,B组注射0.9%氯化钠注射液20ml,同时两组患者均夹闭胸腔闭式引流管10min;记录两组患者胸膜腔用药前以及用药后5min、15min、30min、2h、4h、6h和8h的VAS评分,以及患者满意度和不良反应的发生情况。结果两组患者胸膜腔用药前VAS评分无统计学差异,在用药后5min、15min、30min、2h、4h的VAS评分均有统计学差异(均P<0.05);且A组的患者满意度高于B组,两组患者满意度比较差异有统计学意义(P<0.05);两组间不良反应的发生率比较无统计学差异。结论胸膜腔注射罗哌卡因是胸腔镜肺部手术术后一种安全有效的镇痛方法,可以提供良好的镇痛效果;胸膜腔注射罗哌卡因复合舒芬太尼静脉镇痛可以明显降低胸腔镜肺部手术患者术后疼痛,提高了患者的满意度。

Objective To evaluate the postoperative analgesic effect of plural injection of ropivacaine combined with sufentanil in thoracoscopic lung surgery.Methods Thirty patients with ASA I-III scheduled for video-assisted thoracoscopic(VATS)lung surgery were randomly allocated into two groups(n=15in each group).All patients were routinely given patient-controlled injection analgesia(PCIA)(sufentanil100μg/saline100ml,at2ml/h,bolus dose0.5ml,locking time15min).Patients in study group were given pleural cavity injection of20ml0.75%ropivacaine,while patients in control group were given20ml0.9%saline instead.The VAS scores,patient satisfaction,and the side effects or complications were recorded before thepleural cavity injection and at5min,15min,30min,2h,4h,6h,and8h after injection.Results The VAS scores of study groupwere significantly lower than those in control group at5min,15min,30min,2h,and4h after ropivacaine injection(P<0.05).Compared to control group the patients'satisfaction of study group was significantly improved(P<0.05),while there was no significant difference in the incidence of adverse reactions between two groups.Conclusion Pleural cavity injection of ropivacaine combined with sufentanil for PCIS can effectively and safely reduce the pain and improve the satisfaction of patients after thoracoscopic lung surgery.