开胸术后曲马多及芬太尼联合静脉镇痛及其对呼吸功能影响.docVIP

开胸术后曲马多及芬太尼联合静脉镇痛及其对呼吸功能影响 　【关键词】 ,,镇,,痛 摘 要：目的：观察曲马多复合芬太尼静脉镇痛在开胸术后镇痛及对肺功能的影响。方法：60例择期行肺叶切除术病人(ASAI～II)随机分为2组，观察组（n=30）：1%曲马多+1.5μg/ml芬太尼，对照组(n=30)：0.125%布比卡因+芬太尼2μg/kg ；采用10cm视觉模拟评分尺评估术后1d、2d静息和咳嗽疼痛评分，测量术前和术后1d、2d肺功能(用力肺活量FVC、1s用力呼出量FEV1、呼气峰流速PEF)和血气，记录副作用、肺部并发症和术后住院日。结果：①镇痛效果术后1d、2d硬外组静息和咳嗽VAS评分低于静脉组，但无统计学意义(Pgt;0.05)；②呼吸功能在术后1d、2d 2组肺功能FVC、FEV1、PEF)、动脉血气、呼吸频率无显著差异（Pgt;0.05）；③副作用无显著差异;④均无肺部合并症发生,术住院日无显著差异。结论：曲马多复合芬太尼静脉镇痛应用于开胸手术镇痛效果可行，操作简单，为该类手术镇痛提供了又一种选择。 　　关键词： 曲马多； 镇 痛； 肺功能； 开胸术 　　Effects of Pain and Their Effect on Pulmonary Function of Tramadol with Fentanyl on Patient-controlled Analgesia for Postthoracotomy 　　Abstract： Objective： To observe the effects of pain and their effect on pulmonary function of tramadol with fentanyl on patient-controlled analgesia for postthoracotomy. Method： Sixty patients, ASA grade I～II, undergoing elective pneumonecotomy were randomly divided into two groups: group I(n=30), received patient-controlled analgesia(PCA)with intravenous of tramadol with fentanyl; and group II (n=30)received continuous thoracic epidural bupivacaine with fentanyl. Analgesia was tested using a visual analog pain scale(VAS)(0~10cm). Pulmonary function were measured on 1st and 2nd day postoperatively, The incidence of side-effects, pulmonary complications and the length of hospital stay were also recorded. Results: The pain scores were lower in group II, but compared to group I, there was no significant difference (Pgt;0.05); Pulmonary function and the length of hospital stay was similar in both groups. Conclusion: Tramadol with fentanyl on patient-controlled analgesia is a safe and effective method for postthoracotomy. 　　Key words： Tramadol; Analgesia; Pulmonary function; Thoracotomy 　　本文观察曲马多静脉镇痛对开胸患者的效果及对肺功能影响,并与硬膜外镇痛比较。 　　1 资料与方法 　　1.1 为避免肺病手术本身对呼吸功能的影响,本组均选择ASAI～II，单一肺叶切除手术患者。60例随机分为2组,每组30例。观察组：静脉镇痛：男19例，女11例，年龄15～67岁，平均（40.08±26.89）岁,体重（46.2±16.3)kg；手术种类为左肺肺叶切除16例，右肺叶切除14例。对照组为硬膜外镇痛,男性21例,女性9例；年龄17～67岁，平均（40.74±21.34）岁，体重（45.3±15.6）kg；手术种类为左肺肺叶切除17