CAJ | 학술논문

目的比较胸腔镜下肺叶切除术病人术后病人自控静脉镇痛(PCIA)、病人自控椎旁神经阻滞(PCPB)和病人自控硬膜外镇痛(PCEA)的效果.方法拟行胸腔镜下肺叶切除术病人48例,性别不限,年龄50 ～ 64岁,体重指数20 ～ 25 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将病人随机分为3组(n=16):PCIA组、PCPB组和PCEA组.PCIA组配方:舒芬太尼2μg/kg,用生理盐水稀释到100 ml,背景输注速率2ml/h,锁定时间15 min,PCA量2ml.PCPB组配方:0.75％罗哌卡因60ml,用生理盐水稀释到250 ml,背景输注速率5 ml/h,锁定时间15 min,PCA量5ml.PCEA组配方:0.75％罗哌卡因50 ml+舒芬太尼1μg/kg,用生理盐水稀释到250 ml,背景输注速率5 ml/h,锁定时间15 min,PCA量5ml,维持VAS评分≤3分.分别于术前(基础状态)、术后24和48h时采集外周静脉血样,检测血浆皮质醇浓度,记录不良反应的发生情况.结果与PCIA组比较,PCPB组和PCEA组血浆皮质醇浓度和嗜睡发生率降低(P＜0.05)；与PCPB组比较,PCEA组血浆皮质醇浓度降低(P＜0.05).与基础值比较,PCIA组和PCPB组术后血浆皮质醇浓度升高(P＜0.05),PCEA组血浆皮质醇浓度差异无统计学意义(P＞0.05).结论与PCIA比较,在提供等效镇痛效果的前提下,PCEA可抑制胸腔镜下肺叶切除术病人应激反应,而PCPB可减轻应激反应,且安全性良好.
목적 비교흉강경하폐협절제술병인술후병인자공정맥진통(PCIA)、병인자공추방신경조체(PCPB)화병인자공경막외진통(PCEA)적효과.방법 의행흉강경하폐협절제술병인48례,성별불한,년령50 ～ 64세,체중지수20 ～ 25 kg/m2,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장병인수궤분위3조(n=16):PCIA조、PCPB조화PCEA조.PCIA조배방:서분태니2μg/kg,용생리염수희석도100 ml,배경수주속솔2ml/h,쇄정시간15 min,PCA량2ml.PCPB조배방:0.75％라고잡인60ml,용생리염수희석도250 ml,배경수주속솔5 ml/h,쇄정시간15 min,PCA량5ml.PCEA조배방:0.75％라고잡인50 ml+서분태니1μg/kg,용생리염수희석도250 ml,배경수주속솔5 ml/h,쇄정시간15 min,PCA량5ml,유지VAS평분≤3분.분별우술전(기출상태)、술후24화48h시채집외주정맥혈양,검측혈장피질순농도,기록불량반응적발생정황.결과 여PCIA조비교,PCPB조화PCEA조혈장피질순농도화기수발생솔강저(P＜0.05)；여PCPB조비교,PCEA조혈장피질순농도강저(P＜0.05).여기출치비교,PCIA조화PCPB조술후혈장피질순농도승고(P＜0.05),PCEA조혈장피질순농도차이무통계학의의(P＞0.05).결론 여PCIA비교,재제공등효진통효과적전제하,PCEA가억제흉강경하폐협절제술병인응격반응,이PCPB가감경응격반응,차안전성량호.
Objective To compare the efficacy of patient-controlled intravenous analgesia (PCIA),patient-controlled paravertebral block (PCPB) and patient-controlled epidural analgesia (PCEA) in patients after lobectomy performed via video-assisted thoracoscope (VAT).Methods Forty-eight ASA Ⅰ or Ⅱ patients,aged 50-64 yr,with a body mass index of 20-25 kg/m2,undergoing elective lobectomy via VAT,were randomly divided into 3 groups ( n =16 each):PCIA group,PCPB group and PCEA group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline,The PCA pump was set up with a 2 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.PCPB solution contained 0.75％ ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.The PCEA solution contained 0.75％ ropivacaine 50 ml and sufentanil 1 μg/kg in 250 ml of normal saline.The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤3.Peripberal venous blood samples were obtained before operation ( baseline),and at 24 and 48 h after operation for determination of the plasma cortisol concentration.The side effects were recorded.Results The plasma cortisol concentration and incidence of Somnolence were significantly lower in groups PCPB and PCEA than in group PCIA ( P ＜ 0.05 ).The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB ( P ＜ 0.05).Compared with the baseline value,the plasma cortisol concentrstion was significantly higher after operation in groups PCIA and PCPB ( P ＜ 0.05),while no significant change was found in group PCEA ( P ＞ 0.05).Conclusion Compared with PCIA,PCEA can inhibit the stress response,while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.