【摘要】 目的比较电视辅助胸腔镜手术(VATS)术后持续胸膜外镇痛和持续硬膜外镇痛效果的差异。方法择期在VATS下行肺肿瘤切除术的患者48例,年龄18～65岁,ASAⅠ或Ⅱ级,随机均分为胸膜外阻滞组和硬膜外阻滞组,在术后48h内使用罗哌卡因分别进行持续胸膜外和持续硬膜外镇痛。记录患者术后4、12、24、36和48h的静息和运动时的VAS评分,术后48h内吗啡使用量和氟比洛芬酯使用例数,并记录两组患者术后第1、2天的离床活动例数和术后住院天数。记录术后恶心、呕吐、呼吸抑制、瘙痒和尿潴留不良反应发生率。结果胸膜外阻滞组和硬膜外阻滞组在术后4、12、24、36和48h静止和运动时VAS评分差异无统计学意义,两组患者吗啡使用量和氟比洛芬酯使用例数差异无统计学意义,术后恶心、呕吐发生率,术后第1、2天离床活动例数和术后住院天数差异均无统计学意义。结论两种方法在小剂量吗啡辅助下能提供良好的镇痛效果。由于具备安全准确的优点,电视辅助胸腔镜手术后也可选择持续胸膜外镇痛方法。更多还原

【Abstract】 Objective To compare the analgesic effects of continuous extrapleural block and continuous epidural block after video-assisted thoracoscopic surgery through a randomized and open study.Methods The study subjects were forty-eight patients aged 18 to 65 years and ASA physical status Ⅰ or Ⅱ scheduled for lung resection with VATS.Patients received either continuous extrapleural block or continuous epidural block using ropivacaine for a period of 48 hours after surgery. VAS scores at rest and during movement were recorded at 4, 12, 24, 36, and 48 h after surgery. The dosage of morphine and the consumption of flurbiprofen were recorded during 48 h postoperatively. Incidence of postoperative nausea, vomiting,ambulation and hospital stay after surgery were also recorded.Results There were no significant differences between the extrapleural and epidural block groups with regard to VAS at rest and during movement at 4, 12, 24, 36, and 48 h after surgery, dosage of intravenous morphine, the consumption of flurbiprofen axetil, incidence of postoperative nausea and vomiting, postoperative ambulation and hospital stay after surgery.Conclusion The two methods can provide a good analgesic effect in a small dose of morphineassisted.With the advantages of safe and accurate, the VATS can also choose to continue extrapleural analgesia.更多还原