CAJ | 학술논문

目的：观察自控静脉镇痛（ PCIA）对胸部创伤患者早期呼吸循环功能的影响。方法选择2010年10月～2011年6月伤后12h急诊入住西南医院创伤急救中心的26例胸部闭合性创伤患者，随机分为两组，对照组11例，无镇痛措施；镇痛组15例，入院后予以自控静脉镇痛3 d。对照组11例，男性10例，女性1例；年龄25～47岁，平均（36.65±8.40）岁；镇痛组15例，男性12例，女性3例；年龄23～48岁，平均（35.28±9.73）岁。分别测定入院时（0h）、24、48、72、96h及120h的动脉血气分析中pH值、动脉氧分压（PO2）、动脉二氧化碳分压（PCO2）、指氧饱和度（SpO2）、氧合指数（PaO2／FIO2），HR（心率）、肘部动脉收缩血压、心肌酶谱中谷草转氨酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（α-HBDH），统计分析结果。结果两组在治疗24、48h时PO2和PaO2／FIO2无明显改善，组间对比无明显差异（ P＞0.05）；72、96、120h时两组PO2和PaO2／FIO2（对照组105.8±28.4／221.5±28.7，108.4±30.7／239.4±25.3，142.8±34.3／318.5±35.7；镇痛组131.8±27.5／285.5±32.7，153.4±32.4／328.1±30.6，170.8±20.7／350.2±34.9），组间对比差异明显（P＜0.05）； pH值、PCO2、SpO2行组间对比均无明显差异（P＞0.05）；两组在镇痛后，心率在各时间点行组间对比差异明显（ P＜0.05）；收缩压及心肌酶谱检查结果，两组对比无统计学差异（ P＞0.05）。结论镇痛对胸部创伤早期呼吸功能恢复有良好的治疗作用，可稳定心率，对血压及异常变化的心肌酶谱无明显影响。
목적：관찰자공정맥진통（ PCIA）대흉부창상환자조기호흡순배공능적영향。방법선택2010년10월～2011년6월상후12h급진입주서남의원창상급구중심적26례흉부폐합성창상환자，수궤분위량조，대조조11례，무진통조시；진통조15례，입원후여이자공정맥진통3 d。대조조11례，남성10례，녀성1례；년령25～47세，평균（36.65±8.40）세；진통조15례，남성12례，녀성3례；년령23～48세，평균（35.28±9.73）세。분별측정입원시（0h）、24、48、72、96h급120h적동맥혈기분석중pH치、동맥양분압（PO2）、동맥이양화탄분압（PCO2）、지양포화도（SpO2）、양합지수（PaO2／FIO2），HR（심솔）、주부동맥수축혈압、심기매보중곡초전안매（AST）、기산격매（CK）、기산격매동공매（CK-MB）、유산탈경매（LDH）、α-간정산탈경매（α-HBDH），통계분석결과。결과량조재치료24、48h시PO2화PaO2／FIO2무명현개선，조간대비무명현차이（ P＞0.05）；72、96、120h시량조PO2화PaO2／FIO2（대조조105.8±28.4／221.5±28.7，108.4±30.7／239.4±25.3，142.8±34.3／318.5±35.7；진통조131.8±27.5／285.5±32.7，153.4±32.4／328.1±30.6，170.8±20.7／350.2±34.9），조간대비차이명현（P＜0.05）； pH치、PCO2、SpO2행조간대비균무명현차이（P＞0.05）；량조재진통후，심솔재각시간점행조간대비차이명현（ P＜0.05）；수축압급심기매보검사결과，량조대비무통계학차이（ P＞0.05）。결론진통대흉부창상조기호흡공능회복유량호적치료작용，가은정심솔，대혈압급이상변화적심기매보무명현영향。
Objective To observe the influence of patient-controlled intravenous analgesia( PCIA) on early respiration and circulation in patients with chest trauma. Methods From Oct.2010 to Jun.2011,26 cases of closed chest trauma who were admitted into the trauma emergency center of Southwest Hospital were randomly divid-ed into two groups,the control group,( n=11,no analgesia) and the analgesia group ( n=15,with controlled intra-venous analgesia for three days).In the control group,10 were males and 1 was female with an average age of (36.65 ±8.40)years (25-47 year).In the analgesia group,12 were males and 3 were females with an average age of (35.28 ±9.73)years (23-48 year).PH value,PO2,PCO2,SpO2,PaO2/FIO2,heart rate (HR),arterial elbow systolic blood pressure,myocardial enzymes in the aspartate aminotransferase( AST) ,creatine kinase ( CK) ,creatine kinase isoenzyme(CK-MB),lactate dehydrogenase (LDH),α-hydroxybutyrate dehydrogenase (α-HBDH) on ad-mission (0h),24h,48h,72h,96h and 120h were measured and analyzed. Results Two groups had no significant improvement in PO2 and oxygenation index at the time point of 24h and 48h without significant difference between the two groups(P>0.05).At the time point of 72h,96h and 120h,significant differences were observed between the two groups(P<0.05) in PO2 and PaO2/FIO2(control group:105.8 ±28.4/221.5 ±28.7,108.4 ±30.7/239.4 ± 25.3,142.8 ±34.3/318.5 ±35.7;analgesia group:131.8 ±27.5 /285.5 ±32.7,153.4 ±32.4/328.1 ±30.6, 170.8 ±20.7 /350.2 ±34.9) ,while PH value,PCO2 and SpO2 had no significant difference ( P>0.05) .HR at each time point had significant differences between the two groups( P<0.05);systolic blood pressure and myocardi-al enzyme test results had no significant difference between the groups(P>0.05).Conclusion Early analgesia for chest trauma has good therapeutic effect in restoring respiratory function and stablizing heart rate while having no significant effect on blood pressure and abnormal changes in myocardial enzymes.