摘要
目的:探讨布托啡诺和舒芬太尼两种不同阿片受体激动剂联合肋间神经阻滞,在电视辅助胸腔镜(VATS)下肺叶切除术后镇痛的效果。方法:择期全麻下行VATS肺叶切除术患者80例,随机分成布托啡诺组(B1组)、布托啡诺联合肋间神经阻滞组(B2组)、舒芬太尼组(S1组)和舒芬太联合肋间神经阻滞组(S2组),每组20例。手术结束前30min,B1、B2组给予布托啡诺负荷量30μg/kg,S1、S2组给予舒芬太尼负荷量0.1μg/kg。在关胸前,B2组和S2组以0.375%罗哌卡因20mL阻滞切口至胸腔闭式引流管所在的肋间神经根。术毕B1、B2组分别以布托啡诺3μg/(kg·h)静脉维持,S1、S2组以舒芬太尼0.075μg/(kg·h)静脉维持。记录术毕、术后6、12、18、24、36、48h的平均动脉压、心率、呼吸频率、脉搏氧饱和度、患者平静时的视觉模拟(VAS)疼痛评分及Ramsay镇静评分,以及患者术后24、48h和术后第7天咳嗽时的VAS疼痛评分。术后第1天作动脉血气分析。结果:术后48h内四组患者各观察时点的呼吸循环指标、Ramsay镇静评分比较无显著差异。在术后6～24h各时点,以及术后24、48h和术后第7天患者咳嗽时,B2组和S2组VAS评分均低于B1组和S1组(P<0.05)。术后第1天,B2组和S2组的动脉氧分压和氧合指数均高于B1组和S1组(P<0.05或0.01)。结论:布托啡诺或舒芬太尼两种不同阿片受体激动剂联合罗哌卡因肋间神经阻滞均可安全有效地应用于VATS术后镇痛。
Objective To investigate the effects of butorphanol or sulfentanyl associated with intercostal nerve block （INB） for postoperative pain relief after Video assisted thoracoscopic surgery. （VATS）. Methods 80 patients （28 N 56 years） who underwent VATS lobectomy were rando reLy divided into butorphanol groupl （group B1, n = 20）, INB associated with butorphanol （group B2, n = 20）, sufentanil group（group S1, n = 20） and INB associated with sufentanil （group S2, n = 20）. Postoperative analgesia consisted of continuous intravenous infusion of for 48 h butorphanol or sufentanil for all patients. Loading dose of butorphanol was 30 p.g/kg in group B 1 and B2, and that of sufentanil was 0.1 pμg/kg in group SI and S2 30 rain before the end of operation. 20 mL of 0.375% ropivacaine was ad ministrated for INB in group B2 and S2. Intravenous analgesia maintenance dose of butorphanol in group B1 and B2 was 3 p.g/（kg.h）, and that of sufentanil was 0.075 p.g/（kg.h） in group S1 and S2 after operation, respectively. Recorded the visual analogue score （VAS）, Ramsay sedative scores, blood pressure, heart rate, respiratory rate and SpO2 at 0, 6, 12, 18,24, 36 h, and 48 h after ad ministration; VAS was recorded when patients coughing at 24, 48h and 7 days after ad ministration. Arterial blood gas analysis was performed at the first postoperative day. Results There were no significant differences between the four groups about sedative scores, blood pressure, heart rate, respiratory rate, and SpO2 48 h. The VAS was higher in group B1 and S1 than those in group B2 and S2 during 6 - 24 h and when patients coughing after ad ministration, but no significant difference between group B2 and S2 （P 〈 0.05）. Moreover, INB improved PaO2 and oxygenation index in group B2 and S2 significantly. Conclusion INB associated with butorphanol or sufentanil reduces postoperative pain and provides a better postoperative recovery for adult patients of VATS.
出处
《实用医学杂志》
CAS
北大核心
2012年第18期3121-3124,共4页
The Journal of Practical Medicine
关键词
患者自控镇痛
肋间神经阻滞
胸廓造口术
阿片受体激动剂
Patient-controlled intravenous analgesia
Intercostal nerve block
Thoracostomy
Opiate receptor agonist
