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目的分析胸腔镜肺大疱切除术应用静脉自控镇痛(IPCA)联合术中肋间神经阻滞(INB)的临床疗效。方法纳入我院2013年2月至2015年3月需要手术的肺大疱合并自发性气胸患者共76例,按照随机数字表法随机分为两组:罗派卡因肋间神经阻滞+静脉自控镇痛组(INB+IPCA组)38例,男30例、女8例,年龄(23.63±4.10)岁,术中行INB,术后行IPCA;术后静脉自控镇痛组(IPCA组)38例,男33例、女5例,年龄(24.93±6.34)岁,术后行IPCA。记录一般临床资料及术后疼痛视觉模拟评分(visual analogue scale,VAS),观察镇痛后副反应和肺部并发症;对患者镇痛有关的住院费用进行统计。结果 INB+IPCA组患者术后VAS、发生恶心呕吐、乏力等副反应、肺不张及肺部感染发生率、术后需要口服止痛药物明显低于IPCA组,医疗费用无明显增加。结论 IPCA联合术中罗派卡因INB有利于胸腔镜肺大疱切除患者术后的快速康复。
Objective To analyze the curative effect of thoracoscopic pulmonary bullaectomy with intravenous controlled analgesia (IPCA) and intraoperative intercostal nerve block (INB). Methods Totally 76 patients with pulmonary bullae complicated with spontaneous pneumothorax admitted to our hospital from February 2013 to March 2015 were randomly divided into two groups according to the random number table: Ropivacaine intercostal nerve block + vein There were 38 males and 30 females with an average age of (23.63 ± 4.10) years undergoing INB + IPCA. INB patients underwent IPCA. Postoperative intravenous controlled analgesia (IPCA) group 38 Cases, 33 males and 5 females, age (24.93 ± 6.34) years old, IPCA after surgery. General clinical data and postoperative visual analogue scale (VAS) were recorded. Side effects after analgesia and pulmonary complications were observed. The hospitalization costs related to analgesia were calculated. Results The incidence of postoperative VAS, nausea and vomiting, fatigue and other side effects, the incidence of atelectasis and pulmonary infection in patients with INB + IPCA were significantly lower than those in IPCA group after operation, and no significant increase in medical costs. Conclusions IPCA combined with intraoperative lupercaine INB is helpful for the rapid recovery after thoracoscopic pneumobulbar resection.