肺癌根治术后不同镇痛方式的临床效果比较

目的：观察和比较硬膜外自控镇痛（PCEA）和静脉自控镇痛（PCIA）用于肺癌根治术患者围术期的镇痛效果及其不良反应的发生情况。方法：选择择期全麻下行肺癌根治性切除术的患者1214例，ASAI～II级，依镇痛方式不同分为硬膜外自控镇痛组（PCEA组，n=1023）和静脉自控镇痛组（PCtA组，n=191）。观察围术期两组患者镇痛效果、不良反应及术后康复情况。结果：PCEA组术后2h静止状态下和术后6h、24h活动状态下VAS评分均明显低于PCIA组（P〈O．05）；术后48h的Ramsay评分明显低于PCIA组（P〈0．05）；术后住院时间明显短于PCIA组（P〈0．05）；肺部并发症的发生率、切口感染和术后谵妄、恶心呕吐的发生率均明显低于PCIA组（P〈0．01）。结论：PCEA和PCIA两种镇痛方式用于肺癌根治术患者围术期均可达到满意的临床镇痛效果，但PCEA的用药量更少，镇静作用轻，副反应少，并可以降低肺感染和切口感染的几率，缩短住院时间，更有利于肺癌根治术患者的镇痛和康复。

Comparison of the Analgesic Efficacy and Adverse Effects of Patients Controlled Epidural vs. Intravenous Analgesia after Lung Cancer Radical Resection＊

Objective： To evaluate the analgesia efficacy and side effects of patient-controlled epidural analgesia and patient-con- trolled intravenous analgesia on patients with lung cancer after radical resection. Methods： 1214 ASA I - II patients with pulmonary lobectomy,were divided into patient-controlled epidural analgesia group （PCEA, n=1023） and patient-controlled intravenous analgesia group （PCIA, n=191）. Epidural catheter was placed at T5-6 or T6-7 interspace. At the end of operation, PCEA started with a loading dose ofropivacaine （2.5 mg） and fentanyl （0.05 mg） 5 mL through the epidural catheter, followed by PCEA ofropivacaine （0.15 %-0.2 %） ＋ fentanyl （1.8-3.6 g/mL） in 275 mL （background infusion 3-5 mL/h, bolus dose 3-5 mL, lock-out interval 15 rain）. In group PCIA, the patients were received a loading dose of sufentanil 5 g followed by PCIA of sufentanil （0.5 g/mL） in 275 mL （background infusion 3-5 mLl/h, bolus dose 3-5 mL, lock-out interval 15 min）. The same general anesthesia was given to both groups. The analgesia and sedation were evaluated by visual analogue scale （VAS） and ramsay sedation score （RSS） respectively. Adverse reaction and clinical outcomes were analyzed for PCEA and PCIA groups. Results： One thousand and two patients received epidural analgesia, and one hundred and eighty-six patients received intravenous analgesia, with equivalent baseline patient demographics between two groups. VAS score in the PCEA group was lower than those in the PCIA group, at the postoperative 2 h static state and postoperative 6 h, and 24 h activity （P〈0. 05）. Ramsay score was lower in the PCEA group than those in the PCIA group at the postoperative 48 h （P〈0.05）. The duration of hospi- talization was significantly shorter in the PCEA group than those in the PCIA group （P〈0.05）. The incidence rates of nausea and vomit- ing, pulmonary complications, incision infection and postoperative delirium of PCEA groups were all significantly lower in the PCEA group than those in the PCIA group （P〈0.05）. Conclusion： PCEA and PCIA postoperative analgesia achieved satisfactory analgesic ef- fects on patients undergoing lung cancer radical resection. PCEA had fewer adverse reactions and shorter duration of hospitalization with the advantages to perioperative analgesia and rehabilitation in patient undergoing lung cancer radical resection.