肋间神经阻滞(冷冻)联合自控镇痛对开胸术后镇痛效果的临床观察

Application of intercostal nerve blockade with cryoanalgesia combined with PCIA in post-thoracotomy pain control

目的探讨以冷冻方式进行肋间神经阻滞联合自控镇痛对于开胸术后的镇痛效果,寻求较佳镇痛方案。方法将82例开胸肺部手术患者随即分成3组,分别为A组肋间神经冷冻术(45s)联合静脉自控镇痛、B组肋间神经冷冻术(90s)联合静脉自控镇痛、C组单纯静脉自控镇痛,根据视觉模拟评分法(VAS)进行手术当日及术后第3天疼痛评分,观察生命体征及不良反应。结果 A、B组VAS疼痛评分无统计学差异,但均明显低于C组,术后自主排痰能力得以加强;而B组存在个别患者有明显术区麻木感的现象。结论开胸手术采用肋间神经冷冻可加强术后静脉自控镇痛效果,同时适当减少冷冻时间并不导致镇痛效果的减弱,且术后出现不良反应的可能性更低,可得到更广泛的应用。

Objective To investigate the efficacy of intercostal nerve blockade with cryoanalgesia combined with PCIA in post-thoracotomy pain control. Methods 82 patients undergoing thoracotomy for pulmonary tumor were randomized into 3 groups. The group A used intercostal nerve blockade with cryoanalgesia （45s） combined with PCIA , the group B used intercostal nerve blockade with cryoanalgesia （90s） combined with PCIA, and the group C used PCIA only. The effect was evaluated by visual analogue scales（VAS） from the day of thoracotomy to 3 days after operation. Results The VAS score was not signific, autly different between the group A and B, which was significant- ly lower than tha! in Ihe group C. Tile expectoration ability was significantly better in the group A and B than in the group C. Several patients in the group B had obvious numtmess. Conclusion Intercostal nerve cryoanalgesia com- bined with PCIA can enhance the analgesic effect. The analgesic effect won＇ t be weakened by properly shortening the freezing time, and the possibility of postoperative adverse events will be lower. The therapy is worthy of widely clini- cal use.