围术期应用加巴喷丁对开胸术后慢性疼痛的影响

Effect of perioperative application of gabapentin on chronic pain of post-thoracotomy

目的:评价围手术期应用加巴喷丁对开胸术后慢性疼痛的影响。方法:选择70例ASA I^II级行择期肺癌开胸手术患者,随机分为观察组(A组,n=35)和对照组(B组,n=35)。A组在术前2 h服用加巴喷丁300 mg,术后第1天开始口服加巴喷丁300 mg,tid,持续至手术后10 d,B组服用安慰剂,方法同A组,两组患者全身麻醉前均行胸椎硬膜外腔罗哌卡因复合舒芬太尼连续术中及术后镇痛3 d。随访患者术后第0.5、2、4、6个月慢性胸部疼痛及生活质量情况。结果:术后第0.5、2个月,A组疼痛发生率分别为52.8%、36.1%,B组分别为57.1%、42.9%(P>0.05);术后第4、6个月,A组疼痛发生率分别为19.4%、13.9%,B组分别为25.7%、20.0%(P<0.05)。A组与B组比较,术后疼痛持续时间缩短。两组生活满意度指数B(LSI-B)调查评分在随访的第6个月差异有统计学意义(P<0.05)。结论:围术期口服加巴喷丁可有效预防及降低开胸术后病人慢性疼痛的发生率并提高患者的生活质量。

AIM： To evaluate the effect of perioperative application of gabapentin on chronic pain of post-thoracotomy. METHODS： Seventy patients（ASA physical status Ⅰ-Ⅱ） undergoing elective thoracotomy were randomly divided into two groups：group A（ n = 35） and B（ n = 35）. Group A received 300 mg of gabapentin 2 hours before operation,first day after operation beginning oral gabapentin for 300 mg,Tid,lasted until 10 days after;Group B received placebo,methods with the group A. Thoracic epidural anesthesia was performed using ropivacaine and sufentanil before general anesthesia.All patients received postoperative analgesia for 3days. Patients were followed u P〈0.5, 2, 4, 6months to assess chronic chest pain and quality of life conditions. RESULTS： At 0. 5 and 2 months follow up,the incidences of chronic chest pain in group A were 52. 8% and 36. 1% respectively,those of group B were 57. 1% and 42. 9% respectively（ P〈0. 05）. Similarly,at 4 and 6 months follow up,the incidences of chronic chest pain for groups A and B were 19. 4% /13. 9% and 25. 7% /20. 0% respectively（ P〈0. 05）. The incidence of chronic chest pain of group A was significantly less than that of group B at 4 and 6 months follow up after operation. Group A compared with group B,produced a shorter postoperative pain duration. The life satisfaction index B（ LSI-B） scores between the two groups showed significant differences at the 6th month of follow-up. CONCLUSION： Perioperative oral gabapentin can effectively prevent and reduce the incidence of chronic chest pain of post-thoracotomy and improve the quality of life of patients.