CAJ | 학술논문

目的：探讨开胸食管癌根治手术围术期多模式复合镇痛与传统患者静脉自控镇痛（PCIA ）的镇痛效果及安全性。方法将80例择期行开胸食管癌根治手术的患者分为2组，多模式镇痛的A组（n＝40）于切皮前10 min静脉注射右美托咪定1μg/kg ，注射时间10 min ，并于关胸前选择切口及上下各一肋间和放置胸管的肋间神经进行一次罗哌卡因肋间神经阻滞；传统PCIA的B组（n＝40）于切皮前10 min输注同等量的生理盐水作为对照。两组患者均于手术结束即刻开始运用舒芬太尼行PCIA。分别于术后2、4、6、12、24、48 h各时间点观察患者的视觉模拟（VAS ）镇痛评分、镇静与舒适状态评分、患者自控镇痛（PCA）实际按压次数、舒芬太尼用量及不良发应。结果与B组比较，A 组VAS镇痛评分、舒芬太尼用量、PCA 按压次数、恶心、呕吐、皮肤瘙痒、腹胀、呼吸抑制等不良反应的发生率明显下降，舒适状态评分明显升高，差异均有统计学意义（P＜0．05）；两组患者镇静评分差异无统计学意义（P＞0．05）。结论开胸食管癌根治手术围术期多模式镇痛的效果优于术后传统PCIA方法，不良反应发生率低。
목적：탐토개흉식관암근치수술위술기다모식복합진통여전통환자정맥자공진통（PCIA ）적진통효과급안전성。방법장80례택기행개흉식관암근치수술적환자분위2조，다모식진통적A조（n＝40）우절피전10 min정맥주사우미탁미정1μg/kg ，주사시간10 min ，병우관흉전선택절구급상하각일륵간화방치흉관적륵간신경진행일차라고잡인륵간신경조체；전통PCIA적B조（n＝40）우절피전10 min수주동등량적생리염수작위대조。량조환자균우수술결속즉각개시운용서분태니행PCIA。분별우술후2、4、6、12、24、48 h각시간점관찰환자적시각모의（VAS ）진통평분、진정여서괄상태평분、환자자공진통（PCA）실제안압차수、서분태니용량급불량발응。결과여B조비교，A 조VAS진통평분、서분태니용량、PCA 안압차수、악심、구토、피부소양、복창、호흡억제등불량반응적발생솔명현하강，서괄상태평분명현승고，차이균유통계학의의（P＜0．05）；량조환자진정평분차이무통계학의의（P＞0．05）。결론개흉식관암근치수술위술기다모식진통적효과우우술후전통PCIA방법，불량반응발생솔저。
Objective To investigate the efficacy and safety of multimodal analgesia and patients controlled intravenous analgesia (PCIA) on peri-operative pain in open chest radical operation patients with esophageal carcinoma .Methods Eighty patients with e-sophageal carcinoma underwent open chest radical operation were randomly divided into 2 groups :multimodal analgesia group (group A ,n=40) and simple PCIA group(group B ,n=40) .Patients in group A were injected dexmedetomidine 1 μg/kg through vein by a micro-infusion pump within 10 min before incision ,and blocked the intercostal nerves at the cut and the chest tube places and the upper and lower intercostal nerves of the cut .Patients in group B were injected equal amount of saline as a control in the same way .Patients in both groups were undertaken sufentanil PCIA immediately at the end of the operation .Observation of the VAS score ,sedative and comfortable state ,patients controlled analygesia(PCA) pressing times ,using dosage and side effects of sufentanil on these patients at 2nd ,4th ,6th ,12th ,24th ,48th hour after operation were taked .Results Compared with group B , VAS score ,the dosage of sufentanil ,PCA pressing times ,nausea ,vomiting ,pruritus ,abdominal distension ,respiratory depression and side effects of sufentanil in group A significantly decreased ,and the comfortable score significantly increased .The differences have statistically significant(P<0 .05) .Sedation score between group A and group B has no significant difference(P>0 .05) .Con-clusion Compared with PCIA ,the multimodal analgesia is more effective ,and has less adverse reaction after open chest radical op-eration in patients with esophageal carcinoma .