硬膜外自控镇痛在胸科手术术后镇痛中的临床应用

Application of patient-controlled epidural analgesia after thoracic surgery

摘要:

目的 观察比较硬膜外自控镇痛(PCEA)与静脉自控镇痛(PCIA) 2种镇痛方法在胸科手术后的镇痛效果和不良反应。方法 纳入2015年1月至2016年6月内蒙古医科大学附属医院麻醉科择期行开胸手术患者60例,随机分为PCEA组与PCIA组。2组术后镇痛方法如下。PCEA组:舒芬太尼30 μg+罗哌卡因300 mg+0.9%生理盐水至250 ml,单次量2 ml,持续输注量5 ml/h,锁定时间15 min；PCIA组:舒芬太尼200 μg+0.9%生理盐水至250 ml,单次量2 ml,持续输注量5 ml/h,锁定时间15 min。术后 4、24、48 h采用视觉模拟评分(VAS) 评估静息痛和运动痛。观察比较2组术后 4、24、48 h的Ramsay镇静评分及不良反应(低血压、呼吸抑制、恶心呕吐、咳嗽无力、谵妄躁动)。采用SPSS 22.0软件进行统计分析。根据数据类型,组间比较分别采用方差分析或χ²检验。结果 PCEA组患者术后4、24、48 h的静息痛、运动痛VAS值明显低于PCIA组(P<0.05)。在术后4 h和24 h,PCEA组Ramsay镇静评分优于PCIA组(P<0.05),术后48 h组间比较差异无统计学意义。PCEA组低血压、呼吸抑制、恶心呕吐、咳嗽无力及谵妄躁动的发生率低于PCIA组,但差异无统计学意义。结论 对于胸科手术术后镇痛,0.12%罗哌卡因复合30 μg舒芬太尼的PCEA组镇痛效果优于单用舒芬太尼的PCIA组,且不良反应可能更少。

Abstract:

Objective To observe and compare the analgesic effects and adverse reactions during patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) after thoracic surgery. Methods Sixty patients scheduled for elective thoracotomy in our department from January 2015 to June 2016 were prospectively recruited in this study. They were randomly divided into PCEA group (sufentanil 30 μg+ropivacaine 300 mg+0.9% NaCl to 250 ml, single dose 2 ml, continuous infusion 5 ml/h, lock time 15 min) and PCIA group (sufentanil 200 μg +0.9%NaCl to 250 ml, single dose 2 ml, continuous infusion 5 ml/h, lock time 15 min). The analgesic effects, including resting pain and motor pain, were assessed by visual analogue scale (VAS) at 4,4 and 48 h after surgery. Meanwhile, sedation status was observed by Ramsay sedation scale, and the adverse reactions (hypotension, respiratory depression, nausea and vomiting, weak cough, restlessness and delirium) were recorded. SPSS statistics 22.0 was used to perform the statistical analysis. Analysis of variance or Chi-square test was employed for comparison between groups in different data types. Results The VAS values of resting pain and motor pain were significantly lower in the PCEA group than in the PCIA group at 4,4 and 48 h after operation (P<0.05). At 4 and 24 h, the PCEA group had better Ramsay sedation score than the PCIA group, but no such difference was found at 48 h after operation between the 2 groups. The incidence rates of hypotension, respiratory depression, nausea and vomiting, weak cough restlessness and delirium were lower in the PCEA group than in the PCIA group, but there was no statistical difference. Conclusion For postoperative analgesia after thoracic surgery, PCEA with 0.12% ropivacaine combined 30 μg sufentanil shows better analgesic effect than PCIA with 200 μg sufentanil, and may has less adverse reactions at the same time.