【摘要】 目的 探讨持续静脉镇痛对于胸部创伤后肋骨骨折患者的呼吸与循环功能的影响。

    方法 回顾分析ICU 3年中收治的31例胸部创伤后肋骨骨折患者(除外手术、休克、全身多发伤)。其中持续静脉镇痛组(A组，n=16)，用微量泵输入曲马朵0.25mg/(kg·h)复合芬太尼0.125μg/(kg·h)；非持续静脉镇痛组(B组，n=15),疼痛剧烈时予强痛定100mg肌注。观察入ICU时(未镇痛)、24h、48h 3个时点患者的VAS疼痛评分、Remesay镇静评分、呼吸功能指标( RR、PaCO2、PaO2、SaO2)、循环功能指标( HR、SBP、DBP)的变化。

    结果 (1)A组使用持续静脉镇痛后VAS、RR、PaCO2、HR、SBP、DBP均下降(P<0.05), PaO2、SaO2均上升(P<0.05)。(2)B组24h、48h的RR、PaCO2上升(P<0.05)。(3)B组入ICU时的HR、RR、PaCO2较A组下降(P<0.05)，但24h、48h的RR、PaCO2上升(P<0.05)，48h的HR上升(P<0.05)。两组患者镇静评分各时点差异无显著性(P>0.05)，在持续静脉镇痛过程中，未见呼吸抑制、恶心、呕吐、头晕、尿潴留等不良反应。

    结论 持续静脉镇痛能明显改善胸部创伤后肋骨骨折患者的呼吸与循环功能。

    【关键词】 镇痛；静脉；呼吸；循环；肋骨骨折

    The effects of continuous intravenous analgesia of respiratory and circulatory functions on rib fracture patients

    SHEN Yong-jian，DONG Zhang-li，TANG Ming.

    Department of Anesthesiology，Baoshan Branch，Shanghai First People's Hospital, Shanghai 200940,China

    【Abstract】Objective To study the effects of continuous intravenous analgesia of respiratory and circulatory functions on rib fracture patients with chest trauma.Methods Reviewed and analysed 31 rib fracture patients after chest trauma admitted in ICU in the past three years (except surgery, shock,multiple injured). The patients in group A were received tramadol (0.25mg/(kg·h)) combined with fentanyl (0.125μg/(kg·h)) continuous intravenous by minim-pump was continuous intravenous analgesia group (n=16).The patients in group B only be given fortanodyn 100mg muscle injection when being in pain acuty was not continuous intravenous analgesia group (n=15). VAS scores,Remesay sedative scores,respiratory function： RR,PaCO2,PaO2,SaO2;circulatory function： HR,SBP,DBP were recorded at 0(not analgesia),24,48 hours after admitted in ICU.Results(1) In group A,the VAS,RR,PaCO2,HR,SBP,DBP were decreased after continuous intravenous analgesia(P<0.05), VRS,PaO2,SaO2 were increased (P<0.05) ......