肋间神经阻滞治疗285例开胸手术后疼痛综合征的回顾性分析

Intercostal nerve blockade for management of post-thoracotomy pain syndrome:a retrospective analysis of 285 cases

目的回顾性分析肋间神经阻滞治疗开胸手术后疼痛综合征(PTPS)的效果,并探讨影响疗效的相关因素。方法 选择完成5次肋间神经阻滞治疗的PTPS患者285例,采用疼痛缓解程度评分法,以总疼痛缓解总百分率50%为界分为治疗有效(A)组和治疗无效(B)组,记录两组患者的性别、年龄、术前有无胸背部疼痛、手术部位、术后放化疗、术后情绪、治疗前疼痛持续时间、治疗前疼痛视觉模拟评分(VAS评分)等,分析上述因素与疗效的相关性。结果 治疗后患者总疼痛缓解总百分率>50%者占29.5%(84/285)。两组间年龄、术前有胸背痛、手术取右侧胸部切口、治疗后行化疗、治疗前疼痛VAS评分的差异均无统计学意义(P值均>0.05)。A组治疗后接受胸部放疗和术后情绪低落者的构成比均显著低于B组(P值均<0.05),治疗前疼痛持续时间亦显著短于B组(P<0.05)。性别、手术部位、术后接受胸部放疗、术后情绪低落、治疗前疼痛持续时间与治疗后疼痛缓解程度的总相关性为76.4%,其中治疗前疼痛持续时间的相关性为69.7%。治疗前疼痛持续时间与治疗后疼痛缓解程度呈负相关(r=-0.635,P<0.05)。结论 PTPS的病因主要为直接或间接的肋间神经损伤,影响其疗效的因素涉及整个围术期,早期治疗是提高疗效的关键。

Objective To conduct a retrospective analysis of 285 patients with post-thoracotomy pain syndrome（PTPS）who were treated by intercostal nerve blockade and to explore the factors the affecting efficacy.Methods A total of 285 PTPS patients receiving intercostal nerve block for five times were divided into 2 groups according to total percentage of pain relief（%Max TOTPAR）.The patient with a %Max TOTPAR more than 50% were included in group A and those with less than 50% were included in group B.The clinical records including sex,age,preoperative chest or back pain,surgical site,posttreatment radiotherapy and chemotherapy,postoperative mood,preoperative pain status,duration and visual analogue scale（VAS）pain score were reviewed and analyzed,so as to explore the relevance between the curative effects of the treatment and the above mentioned risk factors.Results After treatment 84 patients（29.5%）achieved a %Max TOTPAR more than 50%.There were no significant differences between A and B groups concerning the age,pretreatment chest or back pain status,right surgical site,posttreatment chemotherapy,VAS pain score before treatment（P0.05）.The rate of chest radiotherapy before treatment,incidence of postoperative mood,and duration of pain before treatment in group A were significantly lower or shorter than those in group B（P0.05）.Multifactor logistic regression showed that the pain relief rate after treatment had a 76.4% correlation with gender,surgical site,posttreatment chest radiotherapy,postoperative mood,and pretreatment duration of pain.The pretreatment duration of pain was significantly correlated with the pain relief after treatment（r =-0.635,P0.05）.Logistic regression showed that the pain relief rate after treatment was 69.7% if the pain duration before treatment was less than 10 months.Conclusion Intercostal nerve injury is the main cause of PTPS.The risk factors of PTPS involves the whole perioperative period.Early treatment is crucial for pain relief.