目的 探讨三种不同自控镇痛方案对肺癌手术病人镇静镇痛的影响.方法 2022年11月～2023年4月行胸腔镜下肺癌手术治疗病人93例.根据术后镇痛方式不同分为静脉自控镇痛组(P组,30例)、静脉自控镇痛联合椎旁神经阻滞组(T组,31例)和静脉自控镇痛联合前锯肌平面阻滞组(S组,32例).比较三组术后视觉模拟疼痛评分(VAS)、Ramsay评分、镇痛泵按压次数、镇静药物使用情况、不良反应,比较T组和S组麻醉平面、阻滞操作时间、阻滞起效时间、阻滞持续时间.结果 静息状态下P组术后2小时、24小时、48小时VAS评分分别为(3.09±0.69)分、(2.83±0.59)分和(2.07±0.51)分,高于 T 组的(1.22±0.33)分、(2.51±0.54)分、(1.57±0.45)分和 S 组的(1.01±0.30)分、(2.23±0.51)分、(1.22±0.25)分,T 组高于 S 组;咳嗽状态下P组术后2小时、24小时、48小时VAS评分分别为(3.63±0.55)分、(3.24±0.67)分和(2.61±0.51)分,高于 T组的(1.45±0.29)分、(2.71±0.56)分、(2.33±0.53)分和 S 组的(1.14±0.28)分、(2.40±0.57)分和(2.03±0.52)分,T组高于S组;三组比较差异有统计学意义(P＜0.05).P组术后2小时、24小时、48小时Ramsay评分分别为(2.21±0.51)分、(2.34±0.56)分和(2.31±0.55)分,T 组分别为(2.23±0.53)分和、(2.35±0.55)分和(2.33±0.54)分,S 组分别为(2.22±0.52)分、(2.36±0.57)分和(2.32±0.55)分,三组比较差异无统计学意义(P＞0.05).P组术后24小时、48小时镇痛泵按压次数分别为(10.18±2.42)次、(14.51±3.20)次,高于T组的(3.32±0.79)次、(6.84±1.62)次和 S 组的(1.17±0.28)次、(2.63±0.62)次,T 组高于 S 组,三组比较差异有统计学意义(P＜0.05).P组术后舒芬太尼追加剂量为(8.05±1.99)μg,舒芬太尼使用总量为(71.53±6.91)μg,多于 T 组的(3.77±0.93)µg、(65.82±5.77)μg和 S 组的(2.23±0.55)µg、(47.54±4.56)μg,T组多于S组,三组比较差异有统计学意义(P＜0.05).S组阻滞操作时间为(5.32±1.77)分钟,短于T组的(12.41±3.42)分钟,阻滞持续时间为(12.51±2.14)小时,长于T组的(10.31±2.01)小时,差异有统计学意义(P＜0.05).S组不良反应发生率为6.25％,低于P组的30.00％,两组比较差异有统计学意义(P＜0.05),但三组比较差异无统计学意义(P＞0.05).结论 三种不同自控镇痛方案镇静效果相当,但静脉自控镇痛联合前锯肌平面阻滞更能提供较好的术后镇痛,镇痛泵按压次数及术后镇痛药物使用更少,不良反应更少.
Effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer
Objective To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P(n=30)was given patient-controlled intravenous analgesia,group T(n=31)received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S(n=32)received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale(VAS)score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results VAS scores in the resting state at postoperative 2 h,24 h and 48 h were(3.09±0.69),(2.83±0.59)and(2.07±0.51)in group P,which were higher than group T[(1.22±0.33),(2.51±0.54)and(1.57±0.45)]and group S[(1.01±0.30),(2.23±0.51)and(1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2 h,24 h and 48 h were(3.63±0.55),(3.24±0.67)and(2.61±0.51)in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56)and(2.33±0.53)]and group S[(1.14±0.28),(2.40±0.57)and(2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2 h,24 h and 48 h yielded statistical difference among three groups(all P＜0.05).Ramsay sedation scores at postoperative 2 h,24 h and 48 h were(2.21±0.51),(2.34±0.56)and(2.31±0.55)in group P,(2.23±0.53),(2.35±0.55)and(2.33±0.54)in group T and(2.22±0.52),(2.36±0.57)and(2.32±0.55)in group S,with no statistical difference(all P＞0.05).The press times of analgesic pump at postoperative 24 h and 48 h were(10.18±2.42)and(14.51±3.20)in group P,which were higher than the group T[(3.32±0.79)and(6.84±1.62)]and group S[(1.17±0.28)and(2.63±0.62)],group T was higher than group S,with statistical difference(all P＜0.05).The additional dose of sufentanil and the total amount of sufentanil used in postoperative period were(8.05±1.99)µg and(71.53±6.91)µg in group P,which were more than the group T[(3.77±0.93)pg and(65.82±5.77)µg]and the group S[(2.23±0.55)μg and(47.54±4.56)µg],group T was higher than group S,with statistical difference(all P＜0.05).Group S had shorter performance time[(5.32±1.77)min]and longer block duration time[(12.51±2.14)h]than those of group T[(12.41±3.42)min and(10.31±2.01)h],with statistical difference(all P＜0.05).The incidence of adverse reactions was 6.25％in group S,which was lower than the group P(30.00％,P＜0.05),and no statistical difference was reported among three groups in the occurrence rate of comparisons(all P＞0.05).Conclusion The sedation effects of the three different patient-controlled analgesia protocols are comparable,but patient-controlled intravenous analgesia combined with serratus intercostal plane block provides better postoperative analgesia for patients undergoing thoracoscopic surgery for lung cancer,which has less analgesic pump presses and lower dose of postoperative analgesic drugs used,and fewer adverse effects.
万方数据
维普
