肋间神经冷冻和硬膜外自控镇痛在胸外科术后镇痛中的比较

Comparison of effect between intercostal nerves cryoanalgesia and patient controlled epidural analgesia on post-thoracotomy pain

目的比较肋间神经冷冻和硬膜外自控镇痛在胸外科术后镇痛中的临床效果。方法将2006年4月至2008年5月开胸手术治疗的89例患者按照随机数字表法随机分为肋间神经冷冻组（A组，47例）和硬膜外自控镇痛组（B组，42例）。比较两种方法在术后疼痛程度评分、术后止痛药物应用次数、术后下床活动时间上的差异。结果A组患者术后疼痛程度评分为（1．49±0．80）分，B组为（2．43±1．21）分，两组比较差异有统计学意义（P〈0．05）。A组和B组术后止痛药物应用次数[（1．28±0．62）、（2．02±1．05）次]、术后下床活动时间[（43．15±12．22）、（64．10±14．25）h]比较差异均有统计学意义（P〈0．05）。结论肋间神经冷冻在治疗效果上优于硬膜外自控镇痛，肋间神经冷冻在胸外科术后镇痛中可以提供满意的镇痛效果。

Objective To compare the effect of postoperative intercostal nerves cryoanalgesia and patient controlled epidural analgesia （PCEA） in patients undergoing thoracic surgery. Methods From April 2006 to May 2008,89 patients undergoing thoracic surgery were randomly divided into intercostal nerves Cryoanalgesia group （group A, 47 cases） and PCEA group （group B, 42 cases）. The scores of pain, use of pain medication and time of out-of-bed activity after the operation were used to evaluate the effect of pain between two groups. Results The scores of pain in group A and group B were （ 1.49 ± 0.80） and （2.43 ± 1.21 ） scores respectively. There were significant differences in the scores of pain. The use of pain medication [ （ 1.28 ± 0.62） times vs （2.02 ± 1.05） times] and time of out-of-bed activity after the operation [ （43.15 ± 12.22） h vs （64.10 ± 14.25） hi were significant difference between the two groups（P〈 0.05）. Conclusions For reducing the post- thoracotomy pain,intercostal nerves cryoanalgesia is superior to PCEA. Intercostal nerves cryoanalgesia can provide satisfactory analgesia after thoracic surgery.