CAJ | 학술논문

目的：探讨硬膜外复合皮下多模式镇痛对开胸食管癌手术切除术的镇痛效果及不良反应。方法将40例择期行开胸食管癌手术切除术的患者分为硬膜外复合皮下镇痛组（A组）和皮下镇痛组（B组）。A组采用术前、术中持续泵注0．15％罗哌卡因、0．00002％舒芬太尼硬膜外持续镇痛，关胸前静脉注射曲马多负荷剂量，术毕采用曲马多、舒芬太尼皮下自控镇痛。B组关胸前静脉注射曲马多负荷剂量，术毕曲马多、舒芬太尼皮下自控镇痛。分别在术后各时段评估患者的视觉模拟评分（VAS）、舒适状态、镇静评分，镇痛药的使用剂量，患者自控镇痛（PCA）按压次数，PCA按压次数比及生命体征、不良反应。结果（1） A组较B组安静及活动状态时的VAS评分、PCA按压次数显著降低，舒适状态评分、PCA按压次数比显著上升（P＜0．05）；（2）两组患者术后基本生命体征，镇静评分，恶心、呕吐、皮肤瘙痒、胸闷等不良反应的发生率差异无统计学意义（P＞0．05）。结论硬膜外复合皮下多模式镇痛用于开胸食管癌手术是一种较佳的多模式镇痛方案。
목적：탐토경막외복합피하다모식진통대개흉식관암수술절제술적진통효과급불량반응。방법장40례택기행개흉식관암수술절제술적환자분위경막외복합피하진통조（A조）화피하진통조（B조）。A조채용술전、술중지속빙주0．15％라고잡인、0．00002％서분태니경막외지속진통，관흉전정맥주사곡마다부하제량，술필채용곡마다、서분태니피하자공진통。B조관흉전정맥주사곡마다부하제량，술필곡마다、서분태니피하자공진통。분별재술후각시단평고환자적시각모의평분（VAS）、서괄상태、진정평분，진통약적사용제량，환자자공진통（PCA）안압차수，PCA안압차수비급생명체정、불량반응。결과（1） A조교B조안정급활동상태시적VAS평분、PCA안압차수현저강저，서괄상태평분、PCA안압차수비현저상승（P＜0．05）；（2）량조환자술후기본생명체정，진정평분，악심、구토、피부소양、흉민등불량반응적발생솔차이무통계학의의（P＞0．05）。결론경막외복합피하다모식진통용우개흉식관암수술시일충교가적다모식진통방안。
Objective To study the analgesia effect and adverse reactions of epidural and subcutaneous multimodal analgesia in thoracotomy esophageal cancer resection operation .Methods Forty patients undergoing elective esophageal cancer resection op‐eration were randomly divided into the epidural and subcutaneous analgesia group (group A) and the subcutaneous analgesia group (group B) ,20 cases in each group .The group A adopted 0 .15% ropivacaine and 0 .00002% sufentanil by continuous pumping infu‐sion before and during operation for continuous analgesia ,then intravenous tramadol was given before closing chest ,tramadol and sufentanil subcutaneous patients self‐control analgesia (PCA)were used after operation for analgesia .The group B was given intra‐venous tramadol before closing chest ,then tramadol and sufentanil patient subcutaneous controlled analgesia after operation were used for analgesia .The scores of the visual analogue scale(VAS) ,comfort scale ,sedative scores ,dose of analgesics ,pressing fre‐quency and pressing frequency ratio of PCA ,vital signs and adverse reactions were assessed at different time periods .Results The VAS scores and pressing frequency of PCA at rest and movement in the group A were remarkably decreased compared with the group B ,while the comfort status score and pressing frequency ratio of PCA were obviously increased ,the differences were statisti‐cally significant(P<0 .05);the occurrence rates of adverse reactions such as the vital signs ,sedative scores ,nausea ,vomitting ,skin itch ,chest distress after operation had no statistically significant differences between the two groups .Conclusion Epidural and sub‐cutaneous multimodal analgesia is a better multimodal analgesia scheme in thoracotomy esophageal cancer resection operation .