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目的:比较全程硬膜外镇痛和单次硬膜外阻滞加静脉自控镇痛对胸外科手术后急性疼痛与慢性疼痛的影响。方法:收集南部战区总医院2018年12月1日至2019年7月1月择期行胸外科手术（开胸食管癌根治术、胸腔镜肺叶切除术、胸腔镜肺癌根治术、胸腔镜肺楔形切除术）的患者60例，年龄18~65岁，随机分为全程硬膜外镇痛组（硬膜外组）和单次硬膜外阻滞加静脉自控镇痛组（静脉组），各组30例。两组在术前均行硬膜外穿刺置管术，并给予0.125%罗哌卡因加0.5 μg/ml舒芬太尼共8 ml，术中间断以同样浓度药物维持。硬膜外组在关闭胸膜前连接硬膜外镇痛泵（0.125%罗哌卡因437.5 mg加0.5 μg/ml舒芬太尼175 μg，以生理盐水稀释到350 ml），静脉组关闭胸膜前拔出硬膜外导管连接PCIA泵（1.5 μg/ml舒芬太尼300 μg，以生理盐水稀释到200 ml）。记录术后3、6、12、24、48、72 h各时点急性疼痛视觉模拟评分（VAS）、恶心呕吐（PONV）例数、镇静评分、补救镇痛药物量和不良反应发生率。记录术后2、4、6个月内伤口慢性疼痛和伤口感觉异常的发生率。结果:本研究中共50例患者符合要求，其中男37例，女13例。硬膜外组患者术后3、6、12、24、48、72 h静息时急性疼痛VAS评分和术后6、12、24 h活动时急性疼痛VAS评分均低于静脉组（n P均0.05)，但硬膜外组补救药物曲马多的需求量明显低于静脉组[（120.0±34.6） mg比（212.5±44.1） mg，n P＝0.016]。静脉组PONV者8例（33.3%），硬膜外组PONV者8例（30.8%），两组差异无统计学意义（n P>0.05）。两组未观察到皮肤瘙痒、呼吸抑制、尿潴留等其他不良反应。n 结论:全程硬膜外镇痛与单次硬膜外阻滞加术后PCIA镇痛相比虽然不能降低胸外科术后慢性疼痛和伤口感觉异常的发生率，但能降低术后急性疼痛评分，同时降低术后72 h内的补救镇痛药物需求量，使更多的患者享受无痛。“,”Objective:To observe the effect of comprehensive epidural analgesia and single epidural block plus patient-controlled intravenous analgesia on acute and chronic pain in patients after thoracic surgery.Methods:Sixty patients scheduled for thoracic surgery (radical resection of esophageal cancer, thoracoscopic lobectomy, thoracoscopic radical resection of lung cancer, and thoracoscopic wedge resection) from December 1, 2018 to July 1, 2019, aged 18-65 years old were enrolled in the General Hospital of Southern Theatre Command. Patients were randomly divided into comprehensive epidural analgesia group (epidural group, n n=30) and single epidural block plus patient-controlled intravenous analgesia group (intravenous group, n n=30). After the thoracic epidural catheter was placed at Tn 4-Tn 5 or Tn 4-Tn 6, all patients were given an experiment dose and 0.125% ropivacaine + 0.5 μg/ml sufentanil total 8 ml. When closing the thorax, thoracic epidural analgesia (TEA) pump (0.125% ropivacaine + 0.5 μg/ml sufentanil, background dose 6 ml, bolus 6 ml, lock time 30 min) was connected to the catheter in epidural group; the epidural catheter were removed and the intravenous patient controlled analgesia (PCA) pump (1.5 μg/ml sufentanil, background dose 0.05-0.06 μg·kg n -1·hn -1, bolus 2 ml, lock time 15 min) were connected in intravenous group. Visual analogue scale (VAS), postoperative nausea and vomiting (PONV), Ramsay sedation scores, supplementary analgesics, the incidence of adverse reaction at 3, 6, 12, 24, 48, 72 h after surgery, and the incidence of chronic pain and wound paresthesia at 2, 4, 6 month after surgery were recorded.n Results:Ultimately, fifty patients were involved in the analysis (37 males and 13 females, aged 18-65 years). Compared with intravenous group, VAS was lower at 3, 6, 12, 24, 48, 72 h in rest and at 6, 12, 24 h in movement after the surgery in epidural group (all n P<0.05). Compared with intravenous group, the incidence of pain-free was higher at 3, 6, 12, 24, 48, 72 h in rest and at 6, 12, 24, 48 h in movement after surgery in epidural group (all n P<0.05). The consumption of remedy analgesics (tramadol) were lower during 72 h after the surgery in epidural group (n P0.05). Pruritus, uroschesis, respiratory depression and other side-effects were not found during the study in both groups.n Conclusion:Although comprehensive epidural analgesia don\'t decrease the incidence of chronic pain and paresthesia for thoracic surgery patients postoperatively, it obviously alleviates the acute postoperative pain and decreases the consumption of remedy analgesics during 72 h after the surgery.