持续肋间神经阻滞与硬膜外阻滞对剖胸术后镇痛效果的对比研究

Comparison Analgetic Effect of Continuous Intercostal Nerve Block with that of Epidual Anaesthesia in Patients after Thoracotomy

目的比较、评价持续肋间神经阻滞与胸段硬膜外阻滞对剖胸术后的镇痛效果。方法350例剖胸手术病人随机分为两组,术后分别施行持续硬膜外阻滞(A组,n=155)与持续肋间神经阻滞镇痛(B组,n=195),按Prince-Henry评分法对术后3天内不同时段疼痛程度进行定量评估,并对两组病人术后动脉血PO2、PCO2以及因镇痛措施所致并发症进行比较。结果两组病人术后自觉疼痛减轻,除术后第4h外,各时段疼痛程度无显著差异(P>0.05),术后动脉血PO2两组间无显著差异(P>0.05),但B组PCO2低于A组(P<0.05)。B组镇痛副反应少于A组。结论持续肋间神经阻滞与硬膜外阻滞对于剖胸术后均有良好的镇痛效果。在镇痛并发症发生率等方面,肋间神经阻滞镇痛方式更具优势。

Objective To compare the analgetic effect of continuous intercostal nerve block (CINB) with that of continuous epidual anaesthesia (CEA) in the patients after thoracotomy. Methods Three hundred and fifty patients undergoing unilateral thoracotomy were randomly divided into both the groups A (receiving CEA,n =155) and B (receiving CINB, n = 195). Postoperative pain was assessed for 72 hours according to Prince - Henry scale, and the comparison of the arterial PO2, PCO2 and complications after the operation between both the groups was made. Results The insignificant difference ( P < 0.05) in the subjective pain relief between both the groups was observed all the time except the fourth hour after the operation.The arterial PO2 in group A was not different from that in group B ( P >0.05),in which the arterial PCO2 and the rate of analgesia - related complication occurrence after the opertion were significant lower in than those in group A ( P < 0.05) . Conclusion Aanal-getic effect of both the CEA and CINB on post- thoracotomy pain is good. We favor CINB because of the significantly lower complication rate in the post - thoracotomy patients.