《中国康复理论与实践》

《中国康复理论与实践》 ›› 2006, Vol. 12 ›› Issue (02): 165-166.

• 临床研究 • 上一篇    下一篇

静脉及硬膜外自控镇痛的镇痛效应及对剖胸术后患者肺功能的影响

刘靖; 米卫东; 张宏   

  1. 解放军总医院麻醉科 北京市 100853
  • 收稿日期:2005-09-13 出版日期:2006-02-25 发布日期:2006-02-25

Effect of Patient-controlled Epidural Analgesia and Patient-controlled Intravenous Analgesia on Pulmonary Function after Thoracotomy

LIU Jing, MI Wei-dong, ZHANG Hong   

  1. The Department of Anesthesiology, General Hospital of PLA, Beijing 100853, China
  • Received:2005-09-13 Published:2006-02-25 Online:2006-02-25

PDF (PC)

摘要： 目的比较静脉自控镇痛(PCIA)与硬膜外自控镇痛(PCEA)的镇痛效果、副作用及对剖胸术后患者肺功能的影响。方法33例(ASAⅠ～Ⅱ级)食道癌择期手术患者随机分为两组PCEA组(n=16)镇痛用药为吗啡(0.1mg/ml)+布比卡因(0.125%);PCIA组(n=17)镇痛用药为吗啡(1mg/ml)+氟哌利多(0.1mg/ml)。测量术前及术后镇痛期间患者呼吸频率(RR)、潮气量(Vt)、肺活量(Vc)及脉搏氧饱和度(SPO2);记录术后患者疼痛评分(VAS)及副作用。结果两组患者术后RR均明显快于术前(P<0.01),而Vt、Vc及SPO2均较术前显著降低(P<0.001),但各指标的组间差异均无显著性(P>0.05)。PCEA组VAS评分明显低于PCIA组,尤其是在患者咳嗽和深呼吸时(P<0.001)。结论剖胸术后PCEA镇痛效果明显优于PCIA,但对术后早期患者肺功能的影响两者相似。

关键词: 镇痛, 患者自控, 静脉自控镇痛, 硬膜外自控镇痛, 肺功能

Abstract: ObjectiveTo compare the effect of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) on pulmonary function in post-thoracotomy patients.Methods33 ASA Ⅰ～Ⅱ patients undergoing selective esophagectomy were randomly divided into the PCEA group (n=16, treated with morphine plus bupivacaine) and PCIA group (n=17, treated with morphine plus droperidol) for 3 days postoperatively. Pulmonary function indices including respiratory rate (RR), tidal volume (Vt), vital capacity (Vc) and pulse oximetry (SpO2) were recorded before operation and on the first 2 days after operation. Pain scores with visual analogue scale (VAS) at rest, deep breathing and with cough, and adverse effects were also recorded.ResultsRR increased, Vt , Vc and SpO2 decreased markedly in both groups postoperatively compared with the base line (P<0.01), but there were no significant differences between two groups. VAS scores were much lower in PCEA group, especially, when the patient was at deep breathing or during coughing (P<0.001).ConclusionPCEA is superior to PCIA in pain relief, but contributes no more than PCIA in improving pulmonary function in post-thoracotomy patients.

Key words: analgesia, patient-controlled, patient-controlled intravenous analgesia (PCIA), patient-controlled epidural analgesia (PCEA), pulmonary function