改进肋骨牵开方法对开胸手术后疼痛的影响

Influence of Pain After Thoracotomy in Therapy with Improved Rib Retraction Technique

目的探讨采用四叶牵开器避开肋间神经方法牵开肋骨对开胸手术后疼痛的影响。方法选择在我院明确诊断需行开胸手术的肺癌或食管癌100例,采用随机数字表法将其分为观察组和对照组2组。观察组51例采用四叶牵开器避开肋间神经方法牵开肋骨进行开胸手术,对照组49例采用常规方法牵开肋骨进行开胸手术,比较两组术后8、24、48 h及1周时疼痛情况,并记录术后总引流量及术后1周内吗啡用量、术后至出院并发症发生情况。结果术后8、24、48 h及1周时观察组视觉模拟评分法评分均低于对照组,差异均有统计学意义(P<0.05);术后总引流量观察组与对照组比较差异无统计学意义(P>0.05);术后1周内吗啡用量观察组低于对照组,差异有统计学意义(P<0.05);术后至出院肋骨骨折发生率观察组低于对照组,差异亦有统计学意义(P<0.05)。结论采用四叶牵开器避开肋间神经方法牵开肋骨进行开胸手术可有效缓解术后疼痛,且不增加术后并发症。

Objective To study the influence on the degree of postoperative chest pain in patients undergoing thora-cotomies using rotatory four-leaf retractor to avoid oppression on intercostal rib muscles. Methods 100 patients with lung cancer or esophageal cancer, who would undergo thoracotomy, were divided into two groups using random digits table. 51 pa-tients in the study group were operated upon using rotatory four-leaf retractor to avoid oppression on intercostal rib muscles in the thoracotomies, and 49 patients in the control group underwent conventional thoracotomies. Performance of pain 8, 24, 48 h and 1 week after operation were compared. Total volume of hydrothorax, dosage of Morphine consumption 1 week after operation and complication situation during the end of operation to discharge were also recorded. Results The visual analogue scale （VAS） scores of pain in study group was lower than that of the control group 8, 24, 48 h and 1 week after operation （P〈0. 05）. There was no significant difference in the amount of thoracic drainage between the two groups （P〉0. 05）. The dosage of Morphine consumption 1 week after operation and rib fracture rates during the end of operation up to discharge in study group was lower than that in control group （P〈0. 05）. Conclusion Application of rotatory four-leaf retractor to avoid oppression on intercostal rib muscles can effectively relieve postoperative pain without significantly increasing the risk of com-plications.