冷冻肋间神经在胸部外科手术后的镇痛作用

Analgesic effect of frozen intercostal nerves in post-thoracotomy patients

目的:观察胸外科剖胸手术后肋间神经冷冻镇痛的效果。方法:选择2003-01/2005-12解放军第三军医大学西南医院胸心外科收治的食管癌、贲门癌手术患者100例。对100例胸外科开胸手术后患者进行随机分组,肋间神经冷冻组和对照组各50例患者,按照视觉模拟评分法观察两组患者术后胸部疼痛情况(0分为无痛,10分为剧痛),术后1,2,3周分别对每组患者用PURTTANBENNET肺功能测定仪器行肺功能检查,主要检测反应术后早期实际肺功能的指标(第1秒钟时间肺活量和每分钟最大通气量)客观评价肋间神经镇痛治疗在胸外科剖胸术后镇痛的作用。结果:100例患者均进入结果分析。①肋间神经冷冻组术后镇痛效果满意,患者视觉模拟评分平均值明显低于对照组(2.20,8.23,P<0.05)。②肋间神经冷冻组患者术后肺功能恢复时间较快。术后第3,7天,肋间神经冷冻组每分钟最大通气量占预计值的百分比明显高于对照组[(52±10)%比(41±13)%,(67±14)%比(48±13)%,P均<0.01];第1秒钟时间肺活量占预计值的百分比也明显高于对照组[(59±10)%比(43±12)%,(65±12)%比(52±15)%;P<0.01或0.05]。③术后第14,21天两组每分钟最大通气量及第1秒钟时间肺活量差异无显著性意义。结论:肋间神经冷冻治疗对剖胸手术后镇痛效果明显,不会对肋间神经造成永久性损害,可使患者术后肺功能早期恢复,有效降低肺部并发症。

AIM： To observe the analgesic effect of frozen intercostal nerves in patients undergoing thoracotomy. METHODS： One hundred surgical patients with carcinoma of esophagus or cardia were treated in the Department of Cardiothoracic Surgery, Southwest Hospital of the Third. Military Medical University of Chinese PLA between January 2003 and December 2005. They all underwent thoracotomy and were randomized into cryoanalgesia group （n=50） and control group （n=50）. Postoperative chest pains of patients were estimated by visual analogue scales （VAS, 0 point as painless and 10 points as severely painful）. PURTI＇AN BENNET lung function measuring equipment was used to conduct pulmonary function test at one, two and three weeks postoperatively, The maximal voluntary ventilation （MVV） per minute and vital capacity （VC） in the first second were monitored to evaluate objectively the analgesic effect of frozen intercostal nerves in patients underwent thoracotomy. RESULTS： Totally 100 patients were involved in the result analysis.（1）The postoperative analgesic effect was satisfying in cryoanalgesia group, and the mean value of VAS score was significantly lower in cryoanalgesia group than in control group （2.20 vs. 8.23, P 〈 0.05）.（2）The marked recovery of pulmonary function occurred in surgical patients of cryoanalgesia group. On the 3^nd and 7^th days postoperatively, the percentage of MVV in predicted value was obviously higher in cryoanalgesia group than in control group [（52±10）%/（41±13）%, （67±14）%/（48±13）%, P 〈 0.01]; The percentage of VC in predicted value was also elevated in cryoanalgesia group [（59±10）% /（43±12）%, （65±12）%/（52±15）%, P 〈 0.01 or 0.05]. （3）There was no significant difference in MVV per minute and VC in the first second between both groups on the 14^th and 21^st days postoperatively. CONCLUSION： Frozen intercostal nerves can remarkably relieve post- thoracotomy chest pain without permanent lesion, and the early recovery of pulmonary function in surgical patients reduces effectively the pulmonary complication.