曲马多联合罗哌卡因行肋间神经阻滞用于肺癌患者术后镇痛的临床研究

摘要

Objective:To prospectively assess the effects of intercostal nerve block with ropivacaine and tramadol on postoperative analgesia in lung cancer patients undergoing radical resection.Methods: Sixty adult lung cancer patients who were scheduled to undergoing elective radical resection operations were included in the study.Patients were randomly allocated to 2 groups:R group and RT group(n=30).At the time of subcutaneous suturing of the thoracotomy wound, intercostal nerve nerves were block with 0.5%ropivacaine in R group and 0.5%ropivacaine combined with 2 mg・ kg -1 tramadol in RT group.The Visual analog scale pain scores at rest, the consumption of sufentanil and the number of patients received pethidine at 0( immediately after patients emerged from anesthesia) , 1, 2, 3, 4, 6,8, 12, 24, 36 and 48 hours after operation were recorded.The side effects were also assessed during the postoperative period.Results:Resting VAS scores were significantly lower in RT group at 4 and 8 hours after operation(P <0.05).Periods in 4 hours to 48 hours after operation,the consumption of sufentanil were significantly lower in RT group(P<0.05).The number of patients received pethidine in R group were larger than that of RT group at 4 and 8 hours after operation ( P<0 .05 ) .There was no differences between the two groups in the incidence of side effects ( P >0 .05 ) .Conclusion: Intercostal nerve block with combined ropivacaine and tramadol results in elimination of postoperative analgesic demand.We conclude that intercostal nerve block with combined ropivacaine and tramadol provides significantly better analgesia compared with ropivacaine alone.%目的：评价曲马多联合罗哌卡因行肋间神经阻滞用于肺癌患者术后镇痛的效果。方法：择期全麻下行肺癌根治术的患者60例，随机分为R组和RT组（ n＝30）。关胸前R组和RT组分别用0.5％罗哌卡因（30 ml）和0.5％罗哌卡因联合2 mg・ kg －1曲马多（30 ml）行肋间神经阻滞。记录术后0、1、2、3、4、6、8、12、24、36、48 h舒芬太尼的用量，评估上述时点患者静息状态下的VAS评分，记录术后使用强痛定镇痛的次数及术后并发症。结果：术后4、8 h，RT组VAS评分明显低于R组（P＜0.05）。术后4～48 h内，RT组舒芬太尼的用量明显低于R组（ P＜0.05）。术后6 h和8 h，R组中术后使用强痛定的次数明显多于RT组（ P＜0.05）。两组患者术后的并发症无差异。结论：2 mg・ kg －1曲马多联合罗哌卡因行肋间神经阻滞镇痛，能增强罗哌卡因的镇痛效果、减少术后阿片类药物用量，且不增加术后并发症。