肺癌手术开胸术后早期呼吸功能恢复视角下的胸段硬膜外镇痛与静脉镇痛比较
Comparison of Thoracic Epidural and Intravenous Analgesia from the Perspective of Recovery of Respiratory Function in the Early Post-Thoracotomy Period in Lung Cancer Surgery.
作者信息
Özden Omaygenç Derya, Çıtak Necati, İşgörücü Özgür, Ulukol Ayşe, Büyükkale Songül, Obuz Çiğdem, Doğru Mustafa Vedat, Sayar Adnan
机构信息
Department of Anesthesiology and Reanimation, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
Department of Thoracic Surgery, University of Zurich, Zurich, Switzerland.
出版信息
Turk Thorac J. 2021 Jan;22(1):31-36. doi: 10.5152/TurkThoracJ.2021.19114. Epub 2021 Jan 1.
OBJECTIVE
Thoracic epidural analgesia (TEA) reduces pulmonary complications after thoracotomy. Hypothetically, this advantage is partially because of the preserved pulmonary function, which is achieved by the reduction of postoperative pain and immobility. This study aimed to compare the principal methods of analgesia through early postoperative spirometric performance and gas exchange parameters after elective lung cancer surgery. TEA or intravenous analgesia (IVA) involving pethidine was used as the principal method in our sample population.
MATERIAL AND METHODS
A total of 62 patients operated via the posterolateral thoracotomy approach were enrolled. Postoperative analgesia was secured using multimodal analgesia with either TEA with 0.1% bupivacaine or IVA. Pain perception was assessed with the visual analog scale (VAS) while at rest and on coughing. Arterial blood samples were collected at 1, 24, and 72 hours postoperatively. Preoperative and third postoperative day spirometric measurements were recorded.
RESULTS
There were no significant differences among the groups in terms of demographic characteristics, properties of surgical technique, and disease-associated conditions. VAS scores of the TEA group were lower at the 72-hour follow-up, but a considerable fraction of these differences did not reach statistical significance. Reduction in the forced expiratory volume in the first second and forced vital capacities was more prominent in the IVA group on the third postoperative day, but these were not statistically significant either. Oxygenation parameters favored TEA but remained comparable. Finally, the pH values were significantly lower in the IVA group at 1 and 72 hours postoperatively (p=0.008 and p=0.02, respectively).
CONCLUSION
We believe that TEA is advantageous over IVA with alteration of respiratory volumes during the early postoperative period.
目的
胸段硬膜外镇痛（TEA）可减少开胸术后的肺部并发症。据推测，这一优势部分归因于肺功能得以保留，这是通过减轻术后疼痛和活动受限实现的。本研究旨在通过择期肺癌手术后早期的肺量计测量表现和气体交换参数，比较主要的镇痛方法。在我们的样本人群中，主要方法采用TEA或含哌替啶的静脉镇痛（IVA）。
材料与方法
共纳入62例经后外侧开胸手术入路的患者。术后镇痛采用多模式镇痛，使用0.1%布比卡因进行TEA或IVA。采用视觉模拟量表（VAS）评估静息和咳嗽时的疼痛感知。术后1、24和72小时采集动脉血样本。记录术前和术后第三天的肺量计测量值。
结果
各组在人口统计学特征、手术技术特性和疾病相关情况方面无显著差异。TEA组在72小时随访时的VAS评分较低，但这些差异中有相当一部分未达到统计学意义。术后第三天，IVA组第一秒用力呼气量和用力肺活量的降低更为显著，但这些也无统计学意义。氧合参数有利于TEA，但仍具有可比性。最后，IVA组术后1小时和72小时的pH值显著较低（分别为p = 0.008和p = 0.02）。
结论
我们认为，在术后早期，TEA在改变呼吸容积方面优于IVA。
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