CAJ | 학술논문

目的：探讨开胸围术期应用多模式镇痛对术后镇痛及镇静效果的影响。方法将60例拟行左侧开胸食管癌根治术患者随机分为两组，各30例。两组均给予咪唑安定、舒芬太尼、维库溴铵和异丙酚麻醉诱导，2％～3％七氟烷及舒芬太尼维持麻醉。对照组采用术后舒芬太尼自控镇痛（ PCIA），观察组在麻醉诱导前采用帕瑞昔布钠静脉滴注＋术中左旋布比卡因肋间神经阻滞＋术后帕瑞昔布钠肌内注射及舒芬太尼PCIA多模式镇痛。观察两组患者术后48 h内各时间点视觉模拟疼痛评分法（ VAS）评分及Ramsay镇静评分情况。结果观察组术后2 h、6 h、12 h、24 h、48 h疼痛VAS评分均低于对照组（ P＜0．01）；两组术后48 h内各时间点Ramsay镇静评分比较差异均无统计学意义（ P ＞0．05）。结论开胸围术期应用多模式镇痛可缓解术后疼痛，减少副作用，提高患者舒适度，而对术后镇静无明显影响。
목적：탐토개흉위술기응용다모식진통대술후진통급진정효과적영향。방법장60례의행좌측개흉식관암근치술환자수궤분위량조，각30례。량조균급여미서안정、서분태니、유고추안화이병분마취유도，2％～3％칠불완급서분태니유지마취。대조조채용술후서분태니자공진통（ PCIA），관찰조재마취유도전채용파서석포납정맥적주＋술중좌선포비잡인륵간신경조체＋술후파서석포납기내주사급서분태니PCIA다모식진통。관찰량조환자술후48 h내각시간점시각모의동통평분법（ VAS）평분급Ramsay진정평분정황。결과관찰조술후2 h、6 h、12 h、24 h、48 h동통VAS평분균저우대조조（ P＜0．01）；량조술후48 h내각시간점Ramsay진정평분비교차이균무통계학의의（ P ＞0．05）。결론개흉위술기응용다모식진통가완해술후동통，감소부작용，제고환자서괄도，이대술후진정무명현영향。
Objective To study the effects of open chest operation stage of application of multimodal analgesia for postopera-tive analgesia and sedation effect.Methods Sixty cases of left open radical resection were randomly divided into two groups, each group contains 30 cases of thoracic esophageal carcinoma.Two groups of midazolam sufentanil,vecuronium bromide and 0,propofol an-esthesia induction,2%~3%seven halothane and sufentanil anesthesia maintenance.The control group took the postoperative sufentanil analgesia( PCIA) and the observation group before anesthesia induction using Rui Celebrex sodium intravenous parecoxib sodium injec-tion+and PCIA multi mode of analgesia of sufentanil l than ropivacaine intercostals nerve block and postoperative.The postoperative 48 h at each time point in the VAS score,Ramsay sedation score.Results In the observation group,after 2 h,6 h,12 h,24 h,48 h VAS pain score lower than those of the control group( P <0.01).The two groups were not statistically significant after operation each time point 48 h Ramsay sedation score difference( P >0.05).Conclusion The multimodal analgesia can relieve postoperative pain,reduce the side effects of application of Rui Celebrex sodium intravenous induction before and after operation conclusion chest operative appli-cation after anesthesia and improve the comfort degree of patients.No significant effect on postoperative sedation.