冷冻肋间神经对食管癌术后镇痛效果的观察

Efficacy of Freezing Intercostal Nerve on Postesophagectomy Analgesia

目的:观察冷冻肋间神经在食管癌术后镇痛中的效果。方法:将40例食管癌手术患者随机分成两组,一组患者采用冷冻肋间神经方法术后镇痛,一组患者采用自控镇痛(PCA)方法术后镇痛,用Prince-Henry(P-H)疼痛评分标准对患者术后8天内的疼痛情况进行测评,并对副作用、镇痛药物使用进行比较,评价镇痛效果。结果:两种镇痛方式术后疼痛均减轻,肋间神经冷冻术后自觉疼痛以背部肩胛骨周围为主,自主起坐及活动上肢时明显,但较轻,前胸壁、侧胸壁切口不痛,咳嗽及深呼吸不痛。PCA镇痛以全伤口疼痛为主。Prince-Henry疼痛评分冷冻肋间神经后疼痛均在2分以下,PCA组除术后2小时和术后第8天外均在2分以上,各时间点比较差异有统计学意义(P<0.05)。冷冻镇痛持续时间长,可以覆盖整个围术期。冷冻镇痛无副作用,PCA镇痛发生嗜睡2例、尿潴留1例、呼吸轻度抑制1例。结论:冷冻肋间神经镇痛效果较PCA好,且副作用少、持续时间长,有利于提高食管癌手术患者围术期生活质量。

Objective： To evaluate the efficacy of freezing intercostal nerve in controlling post-esophagectomy pain. Methods： Forty patients who received esophagectomy were randomly divided into two groups. One group received freezing intercostal nerve while the other group received patient control analgesia（PCA）. The postoperative pain was assessed for eight days with Prince-Henry（P-H） analogue scale, and the comparison of postoperative complications of the two groups was conducted. Results ： Subjective pain was relieved in both groups. Patients with freezing intercostal nerve did not feel pain in incision of anterior and lateral chest wall, but felt little pain in back and around scapula. P-H analogue scores were less than 2 in freezing intercostal nerve group every time, and more than 2 except in the 2nd hour and 8th day in PCA group （P 〈 0.05）. The freezing intercostal nerve group had no complication , but drowsiness, urinary retention and breathe inhibition were observed in PCA group. Conclusion： Freezing intercostal nerve may provide a safe and effective analgesia for esophagectomy with longer analgesia time. Freezing intercostal nerve can improve the life quality of pa-tients accepted esophagectomy.