摘要
目的:探讨芬太尼透皮贴剂复合硬膜外超前镇痛对肺癌患者术后疼痛影响。方法:选取2016年6月-2017年12月在赣州市肿瘤医院行全身麻醉下开胸肺叶切除术的肺癌患者120例,按照随机数字表将其分为对照组(未使用任何超前镇痛),硬膜外组(使用硬膜外超前镇痛),芬太尼组(使用芬太尼透皮贴剂超前镇痛),联合组(使用芬太尼透皮贴剂复合硬膜外超前镇痛),每组各30例。比较围术期的疼痛视觉模拟评分(VAS)、血糖、平均血压心率积,术后血气分析、镇痛泵按压次数、肺部感染率及不良反应。结果:术后6、12、24 h,联合组VAS评分均低于对照组、硬膜外组及芬太尼组,比较差异均有统计学意义(P<0.05);术后24、48 h血糖水平均升高,但联合组血糖水平均低于对照组、硬膜外组及芬太尼组(P<0.05);联合组术中及术后平均血压心率积波动较对照组、硬膜外组、芬太尼组更加平稳正常,其中四组术中1、2 h及术后24、48、72 h比较差异均显著有统计学意义(P<0.01);术后12 h,联合组Pa O_2与Pa CO_2均高于其他三组(P<0.05);联合组术后镇痛泵按压次数少于其他三组(P<0.05);对照组术后出现肺部感染患者2例,其余三组未出现;四组术后不良反应均少见,仅芬太尼组出现1例皮肤瘙痒。结论:芬太尼透皮贴剂复合硬膜外超前镇痛可有效降低肺癌患者术后疼痛,生命体征更平稳,改善术后早期呼吸功能,降低肺部感染并发症,不良反应少,是一种有效、操作简易、安全可靠的多模式联合超期镇痛方法,值得临床推广使用。
Objective：To investigate the effect of Fentanyl Transdermal System combined with epidural preemptive analgesia on postoperative pain in patients with lung cancer.Method：A total of 120 patients with lung cancer underwent open lobectomy under general anesthesia in Ganzhou Tumor Hospital from June 2016 to December 2017 were selected.According to the random number table,they were divided into control group（without anypreemptive analgesia）,epidural group（epidural preemptive analgesia）,Fentanyl group（Fentanyl Transdermal System preemptive analgesia）,combined group（Fentanyl Transdermal System combined epidural preemptive analgesia）,30 cases in each group.The visual analogue score（VAS）,blood sugar,the average blood pressure and heart rate product in perioperative period,blood gas analysis,analgesic pump press times,lung infection rate and adverse reaction after operation were compared.Result：After operation 6,12 and 24 h,the VAS scores in combined group were lower than those of control group,epidural group and Fentanyl group,the differences were statistically significant（P〈0.05）.The blood glucose at 24 and 48 h increased on average,but the blood glucose in combined group were lower than those of control group,epidural group and Fentanyl group（P〈0.05）.The average blood pressure and heart rate product in combined group were more stable than those of control group,epidural group and Fentanyl group,intraoperative 1,2 h and after operation 24,48,72 h,among the four groups were compared,the differences were statistically significant（P〈0.01）.After operation 12 h,the PaO2 and PaCO2 in combined group were higher than those of other three groups（P〈0.05）.The analgesic pump press times of postoperative in combined group was less than those of other three groups（P〈0.05）.There were 2 cases of pulmonary infection in control group and none in the other three groups,and the adverse reactions were rare in four groups,only 1 case in Fentanyl group had skin pruritus.Conclusion：Fentanyl Transdermal System combined with epidural analgesia can effectively reduce postoperative pain in patients with lung cancer,more stable life signs,improve early postoperative respiratory function,reduce pulmonary infection complications,and have less adverse reactions,it is an effective,simple,safe and reliable multi mode combined overdue analgesic method,and worthy to extended use in clinical.
作者
王成连
雷恩骏
WANG Chenglian;LEI Enjun(The First Affiliated Hospital of Nanchang University,Nanchang 330006,Chin)
出处
《中国医学创新》
CAS
2018年第13期17-22,共6页
Medical Innovation of China
基金
江西省卫生计生委科技计划项目(20157199)
关键词
麻醉与镇痛
芬太尼透皮贴剂
肺癌
硬膜外镇痛
超前镇痛
Anesthesia and analgesia
Fentanyl Transdermal System
Lung cancer
Epiduralanalgesia
Preemptive analgesia
