开胸术后冷冻肋间神经镇痛的临床研究

Cryoanalgesia on Intercostal Nerves for Post-Thoracotomy Pain:A Clinical Report

目的观察肋间神经冷冻在开胸术后的镇痛效果。方法将208例开胸术后患者采用不同的镇痛方法分为3组,肋间神经冷冻镇痛组(冷冻镇痛组,n=80):采用JT-1型冷冻手术治疗机冷冻,每根肋间神经冷冻温度为-55℃左右,冷冻时间为90s;人自控镇痛组(PCA组,n=80):术后静脉应用镇痛泵实行人自控镇痛;对照组(n=48):采用临时肌肉注射度冷丁和口服曲马多缓释剂。以视觉模拟疼痛评分法评价疼痛程度,并比较各组术后肺部并发症发生率及第1秒用力呼气容积(FEV1.0)实测值。结果冷冻镇痛组患者疼痛程度显著弱于PCA组和对照组(χ2=74.93,15.04,P<0.05),肺部并发症的发生率也显著低于对照组(6.25%vs.31.25%,P<0.05);冷冻镇痛组的FEV1.0较对照组高(1.97±0.27L vs.1.39±0.14L,P<0.05)。结论冷冻肋间神经可以显著减轻接受开胸手术患者的术后疼痛,并减少肺部并发症的发生。

Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X^2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.