肋间神经冷冻用于开胸术后镇痛的研究

The study on freezing intercostal nerves for the relief of postoperative chest pain

目的探讨肋间神经最佳冷冻时间和最佳镇痛方式。方法在-70℃不同时间下对家犬行肋间神经冷冻,于当天、术后10 d、60 d 分别取材,行病理检查。选择150例患者,随机分为5组,即对照组(肌肉注射镇痛药物镇痛),静脉镇痛泵镇痛组(PCIA),肋间神经冷冻60 s 组,肋间神经冷冻90 s 组和肋间神经冷冻90 s+PCIA 组。记录心率、血压、SO_2、疼痛评分、杜冷丁用量及术后并发症和副反应。结果动物实验中,冷冻时间>90 s 出现褐色印记及明显的神经变性、坏死和纤维断裂;术后10 d,超过90 s 神经变细,术后60 d 神经基本恢复正常。临床研究中,90 s 组和90 s+PCIA组 VAS 疼痛评分优于 PCIA 组和60 s 组,90 s+PCIA 组 VAS 疼痛评分最好。结论肋间神经冷冻术是安全有效的,-70℃时应超过90 s,术后联合镇痛泵效果最好,但有较多副反应。

Objective To explore the best freezing time and the optimum analgesia modality. Methods In dogs, intercostal nerves were froze at -70℃ at different time including 30, 60, 90, 120, 180 s. Samples were got at the operative day, in 10 days and 60 days respectively, then carried on the pathology exam. In clinical study, 150 patients undergoing thoracotomy were randomly designated into 5 groups, all patients were recorded the heart rate, blood pressure, SO2, VAS, the dosage of dolantin, and observed the complications and side effects. Results At operative day, the freezing nerves appeared brown print macroscopically, and presented degeneration, necrosis of the nerve fiber microscopically with more than 90 s. After 10 days, nerves with more than 90 s became thinner than normal. After 60 days, all nerves had no obvious differentiation than normal. In clinical study, both 90 s group and 90 s with PCIA group were significantly better than 60 s group or PCIA group ; The VAS of 90 s with PCIA group was significantly lower than 90 s group but had more side effects such as vomiting, nausea. Conclusions At -70~C ,the freezing time should be no less than 90 s. The freezing intercostal nerves can safely and effectively relieve postoperative chest pain. The effect of analgesia of 90 s with PCIA group is the best, but has many side effects.