不同镇痛方式对开胸术后患者镇痛效果及并发症的影响

Influence of Different Analgesia Methods on Prevention of Post-thoracotomy Pain and Complications

目的探讨静脉自控镇痛(patient controlled intravenous analgesia,PCIA)、肋间神经冷冻以及两者联合镇痛,对开胸患者术后的镇痛效果,同时分析其并发症以及术后辅助用药情况,评价其安全性,以便提高术后镇痛的护理水平。方法将胸外科90例拟开胸患者分为术后应用静脉自控镇痛组(以下简称PCIA组)、肋间神经冷冻组(以下简称冷冻组)、两者联合组(以下简称联合组)各30例。比较3组手术后3 d内的疼痛评分、辅助用药情况,以及相应并发症的发生情况。结果手术后3 d内,冷冻组在静息状态下的疼痛评分明显低于PCIA组;手术后第3天时,其辅助用药量明显少PCIA组(P<0.05);在活动或咳嗽状态下,联合组的镇痛效果均好于冷冻组和PCIA组,辅助用药也少于另外两组(P<0.05)。PCIA组术后发生恶心、呕吐6例,尿潴留1例,嗜睡2例,呼吸抑制1例;联合组发生恶心、呕吐3例,嗜睡1例;冷冻组患者未发生相关并发症。结论联合应用肋间神经冷冻及静脉自控镇痛对开胸手术患者术后镇痛有良好的有效性和安全性,值得临床推广。

Objective To evaluate the efficiency and safety of patient controlled intravenous analgesia, intercostal nerve cryoanalgesia, and the combination of both for preventing post-thoracotomy pain, and to improve nursing skills. Methods Ninety patients were randomly divided into controlled intravenous analgesia group （PCIA group, n=30）, intercostal nerve frozen group （INF group, n=30）, and combination method group （Combination group, n=30） respectively. Within 3 days post-thoracotomy, the pain scores were determined in each group, and meantime, associated medications for releasing pain were recorded and complications were analyzed. Results Within the first 3 days post operation, the pain scores at rest of patients from INF group were dramatically lower than those of patients from PCIA group （P〈0.05）. At the third day post operation, the analgesia effect at active state or in coughing of combination group was better than those of PCIA group and INF group. For associated medications, there were less patients in combination group in need of associated medications （P〈0.05）. Conclusion The combination of intercostal nerve cryoanalgesia and patient controlled intravenous analgesia is an effective and safe method for post-thoracotomy analgesia. thoracotomy; intercostal nerve cryoanaigesia; patient controlled intravenous analgesia