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1、椎旁間隙置管用于肺癌術(shù)后鎮(zhèn)痛18例分析作者：袁天柱，王奇，吉慶春，楊鯤鵬，黃壯士，李敏【摘要】［目的］探討椎旁間隙置管用于肺癌術(shù)后鎮(zhèn)痛的臨床療效。［方法］將54例全身麻醉開胸肺癌患者隨機(jī)平均分為三組。A組:肌注鎮(zhèn)痛法，即術(shù)后疼痛時(shí)每次肌注哌替定1mg/kg；B組:自控硬膜外鎮(zhèn)痛，藥物配方為嗎啡8mg＋0.125％布比卡因100ml，注入速度為2ml/h；C組:經(jīng)壁層胸膜穿孔脊柱旁間隙置管單側(cè)多根肋間神經(jīng)連續(xù)阻滯術(shù)鎮(zhèn)痛,關(guān)胸前直視下置管，接微量泵(ATRAVEOI6200)以4～6ml/h持續(xù)泵入0
2、.15％利多卡因。比較三組肺癌患者術(shù)后6h、12h、24h及48h切口疼痛程度、鎮(zhèn)痛副作用及肺部并發(fā)癥的發(fā)生情況等。［結(jié)果］A組術(shù)后6h、12h、24h及48h的鎮(zhèn)痛效果明顯較B組和C組相同時(shí)間點(diǎn)差（P＜0.05）。B組和C組肺癌患者術(shù)后6h、12h、24h及48h鎮(zhèn)痛效果均滿意，兩組間無顯著性差異（P＞0.05）。C組鎮(zhèn)痛副作用及并發(fā)癥較A組和B組明顯減少(P<0.05)。［結(jié)論］脊柱旁間隙置管用于肺癌術(shù)后鎮(zhèn)痛簡(jiǎn)單、安全易行、效果良好?！娟P(guān)鍵詞】肺腫瘤AnAnalysisofPara-ve
3、rtebralSpaceCatheterizationonPostoperativeAnalgesiafor18CaseswithLungCancerafterThoracotomyAbstract:［Purpose］Toexploretheclinicaleffectsofpostoperativeanalgesiabymeansofpara-vertebralspacecatheterization(PVSC)forlungcancerafteroperation.［Methods］Fifty
4、-fourcaseswithlungcancerscheduledforthoracicsurgeryundergeneralanesthesiawererandomizedequallyintothreegroups.GroupA:intramuscularinjectiongroup,namelythepatientswhofeltpainwereadministeredintramuscalarigpethidinewith1mg/kgeverytimeafteroperation;Grou
5、pB:patient-controlledepiduralanalgesia(PCEA)group,receivedmorphine8mg+0.125%bupivacaine100mlcontinuousinfusionwith2ml/hafteroperation;GroupC:continuousblockseveralintercostalnervesbymeansofPVSCatthetimeofthoracotomyclosure,received0.15％lidocainecontin
6、uousinfusionwith4～6ml/hbyminimpump(ATRAVEOI6200).Incisionpaindegreeat6h,12h,24hand48hafteroperation,andsideeffectsofpostoperativeanalgesia,incidenceofpulmonarycomplicatingdiseasesamongthethreegroupswerecompared.［Results］Thescoresofanalgesicscaleofgrou
7、pBandgroupCat6h,12h,24hand48hafteroperationweresignificantlysuperiorthanthatingroupArespectively(P<0.05),buttherewasnosignificantlydifferencebetweengroupBandgroupC(P＞0.05).Thesideeffectsandpulmonary5complicationsingroupCweresignificantlylowerthanth
8、oseingroupAandgroupC(P<0.05).［Conclusion］ThetechniqueofPVSCiseasyperforming,safeandeffectivetorelievepainforpostoperativelungcancer.Keywords:lungneoplasms;paravertebralspace;epiduralanalgesia;postoperativecomplications;thoracotomy剖胸術(shù)后因創(chuàng)傷大而疼
