肋间神经保护对剖胸术后疼痛改善的随机前瞻研究

Effect of bilateral intercostal nerve protection on post-thoracotomy pain relief： a prospective single-blinded randomized study

目的通过保护后外侧剖胸切口双侧肋间神经，评估患者术后近期疼痛改善的幅度，并了解不同程度的保护对术后疼痛的改进作用。方法自2006年10月10日至2007年4月10日满足入选标准的患者共60例，均采用后外侧剖胸切口入胸。按照前瞻性单盲随机对照研究要求，将患者随机分为传统后外侧切口组（对照组，18例）、单侧肋间神经保护组（单侧组，20例）、双侧肋间神经保护组（双侧组，22例）3组。疼痛分级采用数字疼痛强度分级法。记录患者术后不同时间点疼痛评分及镇痛药物的用量。结果双侧组术后2—7d及术后1个月切口疼痛均明显轻于对照组（P〈0．05）。单侧组术后2、3、5、7d切口疼痛明显轻于对照组（均P〈0．05）。双侧组胸管拔除后1d较拔管前疼痛有明显缓解（P=0．020），单侧组及对照组疼痛缓解不明显（P值分别为0．091，0．768）。3组患者并发症发生率差异无统计学意义。结论与传统手术相比，保护切口双侧肋间神经可以明显减轻术后急性疼痛程度，尤以术后1个月时疼痛缓解最为明显。这种方法并不增加并发症发生率。

Objective To study the efficacy of bilateral intercostal nerve protection on pain relief after thoracotomy. Methods Sixty patients in need of thoracotomy were. randomized into 3 groups： Group C （ control group, undergoing standard posterolateral thoracotomy, n = 18 ）, Group U （ unilateral intercostal nerve protection group, undergoing protection of intercostal nerve above the incision based on the standard posterolateral thoracotomy, n = 20） , and Group B （ bilateral intercostal nerve protection group, undergoing protection of intercostal nerves above and below the incision based on the standard posterolateral thoracotomy, n = 22）. Numeric rating scale （NRS） was adopted to document the severity of pain at different time points after surgery. The amount of analgesic use was recorded as well. Results The pain scores recorded on the postoperative days 2 to 7 and 1 month after surgery of Group B were all significantly lower than those of Group C （ all P 〈 0.05 ）. Significant pain relief was observed in Group U within the 7 postoperative days compared with Group C; however, there were not significant differences in pain scores among different groups I month after surgery. Pain relief after the removal of chest tubes was found only in Group B （P = 0.020）. The incidence of morbidity was similar among the 3 groups. Conclusion Protection of bilateral intercostal nerves around the incision contributes to significant pain relief after operation without increase of the morbidity of complications.