摘要
目的比较胸腔镜下肺叶切除术病人术后病人自控静脉镇痛（PCIA）、病人自控椎旁神经阻滞（PCPB）和病人自控硬膜外镇痛（PcEA）的效果。方法拟行胸腔镜下肺叶切除术病人48例，性别不限，年龄50—64岁，体重指数20—25kg／m2，ASA分级I或Ⅱ级，采用随机数字表法，将病人随机分为3组（n=16）：PCIA组、PCPB组和PCEA组。PCIA组配方：舒芬太尼2ug/kg，用生理盐水稀释到100nd，背景输注速率2ml／h，锁定时间15min，PCA量2ml。PCPB组配方：0．75％罗哌卡因60ml，用生理盐水稀释到250ml，背景输注速率5ml／h，锁定时间15min，PCA量5ml。PCEA组配方：0．75％罗哌卡因50ml＋舒芬太尼1gg／kg，用生理盐水稀释到250ml，背景输注速率5ml／h，锁定时间15min，PCA量5ml，维持VAS评分≤3分。分别于术前（基础状态）、术后24和48h时采集外周静脉血样，检测血浆皮质醇浓度，记录不良反应的发生情况。结果与PCIA组比较，PCPB组和PCEA组血浆皮质醇浓度和嗜睡发生率降低（P〈0．05）；与PCPB组比较，PCEA组血浆皮质醇浓度降低（P〈0．05）。与基础值比较，PCIA组和PCPB组术后血浆皮质醇浓度升高（P〈0．05），PCEA组血浆皮质醇浓度差异无统计学意义（P〉0．05）。结论与PCIA比较，在提供等效镇痛效果的前提下，PCEA可抑制胸腔镜下肺叶切除术病人应激反应，而PCPB可减轻应激反应，且安全性良好。
Objective To compare the efficacy of patient-controlled intravenous analgesia （PCIA）, patient-controlled paravertebral block （PCPB） and patient-controlled epidural analgesia （PCEA） in patients after lobectomy performed via video-assisted thoracoscope （VAT）. Methods Forty-eight ASA I or II patients, aged 50-64 yr, with a body mass index of 20-25 kg/m2 , undergoing elective lobectomy via VAT, were randomly divided into 3 groups （ n = 16 each） ： PCIA group, PCPB group and PCEA group. PCIA solution contained sufentanil 2 ug/kg in 100 ml of normal saline. The PCA pump was set up with a 2 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h. PCPB solution contained 0.75% ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 5 ml/h. The PCEA solution contained 0.75% ropivacaine 50 ml and sufentanil 1 ug/kg in 250 ml of normal saline. The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h. VAS score was maintained ≤ 3. Peripheral venous blood samples were obtained before operation （baseline）, and at 24 and 48 h after operation for determination of the plasma cortisol concentration. The side effects were recorded. Results The plasma cortisol concentration and incidence of somnolence were significantly lower in groups PCPB and PCEA than in group PCIA （ P 〈 0.05 ）. The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB （ P 〈 0.05 ）. Compared with the baseline value, the plasma cortisol concentration was significantly higher after operation in groups PCIA and PCPB （ P 〈 0.05）, while no significant change was found in group PCEA （ P 〉 0.05）. Conclusion Compared with PCIA, PCEA can inhibit the stress response, while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第3期330-333,共4页
Chinese Journal of Anesthesiology
关键词
疼痛
手术后
镇痛
病人控制
输注
静脉内
神经传导阻滞
镇痛
硬膜外
Pain, postoperative
Analgesia, patient-controlled
Infusions, intravenous
Nerve block
Analgesia, epidural
作者简介
通信作者：韩建阁，Email：hanjiange@163．com
