【摘要】 目的　研究开胸术后病人自控硬膜外镇痛 (PCEA)的临床效果以及对肺部并发症的影响。方法　将全组病例随机分为三组。A组 6 8例采用肌注镇痛法 (哌替啶 1mg/kg) ;B组 5 3例实施病人自控静脉镇痛 (芬太尼 0 0 2 μg/L +氟哌利多 0 0 5 μg/L) ;C组实施PCEA(0 12 5 %罗哌卡因 +芬太尼 0 0 0 2 μg/L)。统计各组术后 12、2 4、4 8、72h各时点的静息疼痛强度 (R VAS)和咳嗽时疼痛强度 (C VAS)以及 5 0 %疼痛缓解率 ,记录不良反应和肺不张、肺部感染等并发症情况。结果　R VAS值 :A组 >C组 ,差异有非常显著意义 (P<0 0 1)。C VAS值 :A组 >C组 ,差异有非常显著意义 (P <0 0 1)。A组 5 0 %疼痛缓解率明显小于B、C组 ,差异有显著意义 (P <0 0 1)。C组术后肺不张、肺部感染的发生率低于A组 ,差异有显著意义 (P <0 0 5 ) ;肺部感染的发生率低于B组 ,差异有显著意义 (P <0 0 5 )。结论　开胸术后实施PCEA能明显缓解术后疼痛 ,降低术后肺部并发症的发生率。更多还原

【Abstract】 Objective To study the effect of patient controlled epidural analgesia(PCEA) and it’s influence on pulmonary complications after thoractomy.Methods Patients were divided into group A(68 patients),B(53 patients) and C(48 patients) randomly.After thoractomy,group A were treated with pethidine 1mg/kg intramuscular injection per time;group B experienced patient controlled intravenous analgesia with fentanyl 20μg/ml and holoperidol 50μg/ml;group C underwent PCEA with 0.125% ropivacaine and fentanyl 2μg/ml.Resting visual analogue scale(R VAS),cough visual analogue scale(C VAS) at 12h,24h,48h,72h postoperation and 50% pain remission rate in each group were analyzed statistically after thoractomy.Side reactions,incidence of atelectasis and pulmonary infectin after operation were recorded simultaneously.Results R VAS and C VAS values in group A were significantly higher than those in group C(P<0.01),50% pain remission rate in group A were significantly lower than that in group B and group C(P<0.01).The incidence of postoperative atelectasis and pulmonary infection in group C were lower than those in group A(P<0.05).The incidence of postoperative pulmonary infection in group C was lower than that in group B(P<0.05).Conclusion PCEA can relief postoperative pain in patients suffered from thoractomy,lower the incidence of pulmonary complications after surgery effectively and then improve patients’ life quality.更多还原