多发肋骨骨折的应用胸膜腔镇痛20例疗效观察.docVIP

多发肋骨骨折的应用胸膜腔镇痛20例疗效观察 　　【摘要】 目的：探讨胸膜腔穿刺置管注入布比卡因用于多发肋骨骨折伤后镇痛的方法及可行性。方法：选择创伤性多发肋骨骨折患者40例，按照时间顺序随机分为治疗组和对照组，每组20例。治疗组行胸膜腔穿刺置管，给予0.5%布比卡因5 ml负荷量，PCA泵将0.15%布比卡因以3 ml/h持续泵入，PCA量2～3 ml，锁定时间30 min；对照组首先肌注哌替定50 mg，并予剧烈疼痛时重复给药50 mg/次。在镇痛后不同时间监测MAP、HR、R、SpO2。采用视觉模拟评分法（VAS）评价镇痛效果。记录镇痛全过程并发症的发生率。结果：治疗组产生良好的镇痛效果，VAS评分均明显低于对照组，其MAP、HR、SpO2与对照组比较差异均有统计学意义（P0.05），且咳嗽排痰良好，无恶心呕吐、肺不张等并发症。结论：胸膜腔穿刺置管PCA注入局麻药用于多发肋骨骨折伤后镇痛安全有效。 　　【关键词】 镇痛； 肋骨骨折； 布比卡因； 胸膜腔穿刺术； 胸膜腔 　　中图分类号 R683.1 文献标识码 B 文章编号 1674-6805（2015）23-0046-03 　　Clinical Observations on Analgesia of Pleural Cavty about Multiple Fracture of Ribs/YUE Shu-gui，WANG Zhen-qian.//Chinese and Foreign Medical Research，2015，13（23）：46-48 　　【Abstract】 Objective：To evaluate the application effect of injecting bupivacaine in pleural catity for analgesia about multiple fracture of irbs after wound.Method：40 patients with traumatic fracture of ribs，were randomly divided into two groups，text group and control group.The patients of text were made thoracocentes and placed ectradinal duct.Following the end of made，5 ml bupivacaine which loaded dose of 0.15% was given，then 0.15% bupivacaine was infused continuously at 3ml/h using a PCA pump，with the PCA bolus dose of 2～3 ml，and lockout time of 30 min In the group control，first were injected dolantin 50 mg in muscle，and was given another 50 mg when the patient felt very pain.MAP，HR，SpO2 and score of visual analgscale（VAS）were measicved at various analgesia times.Rusult：The analgesia was good in the group text.The score of VAS was lower in the group test than the control.MAP，HR，SpO2 had different obviously between the two groups.The group text brought smoothly up the phlegm on coughing，without the occurrence of nauses，vomiting and pulmonary complications.Conclusion：Thoracocentesis and placed eclradural duct for PCA bupivacaine can be applied effectively and safely to analgesia about multiple fracture of ribs after wound. 　　【Key Words】 Analfesia； Fracture of ribs； Bupivacaine； Thoracocentesis； Pleural