不同镇痛方式对开胸术后的镇痛效果及肺部并发症的影响

Effect of different analgesia to acesodyne effect and complications after thoracotomy

目的:评价肋间神经冷冻镇痛、静脉自控镇痛泵及肌注杜冷丁三种方法对胸部肿瘤手术后患者镇痛效果、镇痛相关并发症及对肺部并发症的影响。方法:对138例开胸患者术前随机分为:A组(46例)肋间神经冷冻组;B组(46例)静脉自控给药组;C组(46例)肌注给药组。观察术后的疼痛视觉模拟评分(VAS)、咳嗽咳痰、镇痛相关并发症及肺部并发症的发生情况。结果:A组VAS明显低于B组(P<0.05)和C组(P<0.01);A组咳嗽、咳痰明显优于B组和C组;A组镇痛相关并发症发生率(2.17%)明显低于B组(10.87%)及C组(23.91%);A组肺部并发症的发生率明显低于B组(P<0.05)和C组(P<0.01)。结论:肋间神经冷冻是开胸术后一种安全有效的镇痛方法,优于静脉自控给药及肌注给药,并可有效减低肺部并发症的发生率。

Objective：To compare the effectiveness of different analgesia and influence to postoperative complications. Methods：Total of 138 patients after thoractomy were divided into 3 groups （each with 46 cases） ：group A recieved intercostals nerve freezing;group B used analgesia intravenously;group C received analgesic intramuscularly. The visual analogue scales （VAS） , cough and expectorate, analgesia and resparotory complications were compared among three guoups. Results：The VAS in group A was lower than group B（P 〈0.05） and group C（P 〈0.01 ） ;Postoperative cough and expectorate function in group A were much better than in group B and group C ; the occurrence of analgesia complications were much lower in group A （2.17%） than in group B （10.87%） and group C （23.91） ;the incidence of postoperative resparotory complications were much less in group A than in the other two groups. Conclusion. Cryoanalgesia to intercostals nerve is safe and effctive on prevention of incision pain after thoractomy with a low incidence of postoperative pulmonary complications.