肋间神经冷冻用于开胸手术患者术后镇痛的效果

Efficacy of intercostal nerve cryoanalygesia in patients underwent thoracotomy

目的观察肋间神经冷冻用于食管癌手术后镇痛的效果。方法择期行食管癌根治术的患者60例,随机均分为两组。A组开胸后即刻行肋间神经冷冻;B组则在关胸前实施肋间神经冷冻。记录术后72h患者口述疼痛数字评分(NRS);测定麻醉前、手术2h、术毕、术后12、24h血浆P物质浓度。结果 A、B组镇痛有效率相仿(96.6%vs.93.3%)(P>0.05)。A组术后48h内的NRS评分均明显低于B组(P<0.05)。两组术中和术后血浆P物质浓度均明显高于术前(P<0.05或P<0.01);但A组术中和术后血浆P物质浓度均明显低于B组(P<0.05或P<0.01)。结论肋间神经冷冻的术后镇痛效果满意,在开胸后即刻行肋间神经冷冻疗效更好。

Objective To observe the efficacy of intercostal nerve cryoanalygesia（ICNCA） in patients underwent thoracotomy.Methods A total of 60 patients undergoing esophageal cancer surgery was equally randomized into two groups of A（ICNCA at the time of chest opening） and B（ICNCA at the time before chest closing）.Pain numeral rating pain scales（NRS） were recorded within 72 hours after operation.Serum concentration of substance P was examined before and at 2 h during operation,at the end of operation,and 12,24 h after operation.Results The effectiveness rates of postoperative analgesia were 96.6% and 93.3% for groups of A and B（P0.05）.NRS pain scores within 48 hours after operation were lower in group A than those in group B（P0.05）.Serum concentrations of substance P were higher at 2 h during operation and within 48 hours after operation,which were lower in group A than those in group B（P0.05 or P0.01）.Conclusion ICNCA is an effective method of pain control for postthoracotomy.The efficacy of analgesia is better when ICNCA is performed at the time of chest opening.