肋间神经冷冻对开胸术后切口处感觉近远期的影响

Analysis of the effect of intercostal nerve cryoanalgesia for post-thoracotomy pain control and the chronic discomfort of the incision

目的探讨肋间神经冷冻对开胸术后患者切口处近期镇痛及远期不良感觉的影响。方法前瞻性分析，选择标准胸后外侧切口患者200例，经性别分层后，随机平均分为5组。A组为对照组、B组为静脉泵镇痛组、C组为硬膜外镇痛泵组、D组为单纯肋间神经冷冻镇痛组、E组为肋间神经冷冻联合硬膜外镇痛组，术后7日内对所有患者行VAS疼痛评分，记录患者术后7日内肌注盐酸哌替啶剂量，记录与镇痛措施相关的不良反应。术后门诊或电话随访患者的伤口不适情况，随访时间为术后第3和第6个月。结果术后1周D、E组平均VAS评分和盐酸哌替啶用量低于其他各组。D组术后镇痛不良反应发生率明显低于其他各组。术后中远期A、D、E组切口附近疼痛和不适等不良感觉发生率明显高于B、C组。结论肋间神经冷冻能有效地缓解开胸术后患者近期疼痛，效果明显，不良反应发生率低。肋间神经冷冻会增加开胸患者术后切口的中远期疼痛和不适感。

Objective To evaluate the effect of intercostal nerve cryoanalgesia for post-thoracotomy pain control and the chronic discomfort of the incision. Methods A prospective analysis was carried out in 200 patients after standard posterolateral thoracotomy. Then the patients were randomly divided into five groups after gender stratification, each group with 40 patients. Group A was the control group, which was received no advanced method to prevent the pain after operation, only with Pethidinc injected while patient require. Group B was PCIA group. Group C was PCEA group. Group D was eryoanalgesia group. Group E was cryoanalgesia and PCEA group. VAS score was used in the consecutive 7 days after operation. And we recorded the doses of pethidine injected in the 7 days, as well as the complications and the side effects. On the third and sixth month, patients were followed up by telephone or clinic review for their pain control and discomfort of the incision. Results The VAS score and the average doses of using Pethidine were lower in group D and group E than that in other groups. Group D had a lower ratio of nausea, vomiting, pruritus and lethargy than any other group. Group A, group D and group E had a higher ratio of pain of incision and other adverse reactions than group B and group C. Conclusion Intercostal nerve cryoanalgesia could effectively relief the postoperative pain, reduce the ratio of traumatic stress reaction and side effect. Cryoanalgesia may be a factor that could add the chronic discomfort of the incision.