肋间神经冷冻在开胸术后减轻切口疼痛疗效观察

Effect of intercostal nerve cryotherapy on incisional pain after thoracotomy

目的 探讨肋间神经冷冻在开胸术后减轻切口疼痛中的应用价值.方法 选取2014年10月至2016年7月76例择期行开胸手术患者,通过随机数表法分为两组,每组38例.对照组采用静脉自控镇痛,研究组采用肋间神经冷冻法.统计对比术后不同时间段两组疼痛程度（VAS）、手术前后血清炎性因子[白细胞介素-6（IL-6）、C-反应蛋白（CRP）]及应激反应相关指标（血管紧张素、皮质醇、β-内啡肽）、肺功能[呼气峰流速（PEF）、第1 s用力呼气量（FEV1）、用力肺活量（EVC）]水平变化情况,并统计两组不良反应发生率.结果 ①疼痛程度：术后即刻、1 h、4 h、8 h、12 h研究组VAS评分均低于对照组,差异有统计学意义（P〈 0.05）;②应激反应：术前两组β-内啡肽、皮质醇及血管紧张素水平比较差异未见统计学意义（P〉0.05）,术后1 d研究组各指标水平低于对照组,差异有统计学意义（P＆lt;0.05）;③血清炎性因子：术前两组IL-6、CRP水平比较差异未见统计学意义（P〉0.05）,术后1 d研究组各指标水平低于对照组,差异有统计学意义（P＆lt;0.05）;④肺功能：术前两组PEF、FEV1、EVC水平比较差异未见统计学意义（P〉0.05）,术后1 d研究组各指标水平高于对照组,但差异未见统计学意义（P〉0.05）,术后3 d研究组PEF、FEV1、EVC水平明显高于对照组,差异有统计学意义（P＆lt;0.05）;⑤不良反应：研究组不良反应发生率（13.15%）低于对照组（36.83%）,差异有统计学意义（P＆lt;0.05）.结论 肋间神经冷冻可缓解开胸术后疼痛感,减轻机体炎性反应与应激反应程度,改善患者肺功能,且安全性较高.

Objective To investigate the application value of intercostal nerve cryotherapy on incisional pain after thoracotomy.Methods Seventy-six patients underwent open thoracotomy from October 2014 to July 2016 were randomly divided into two groups, with 38 patients in each group.The control group received intravenous controlled analgesia, the study group received intercostal nerve cryotherapy.The different postoperative time of two groups of pain （VAS） before and after surgery, serum inflammatory factor [interleukin-6 （IL-6）, C reactive protein （CRP）] the relevant indicators and stress response （angiotensin, cortisol and beta endorphin）, pulmonary function （peak expiratory flow rate PEF 1 s）, forced expiratory volume （FEV1）, forced vital capacity （EVC） level changes were made statistical comparison.And the incidence of adverse reactions in the two groups was statistically analyzed.Results ① The degree of pain： VAS scores at immediately after surgery, 1 h, 4 h, 8 h, 12 h in study group were lower than those in the control group, the differences were significant （P〈 0.05）;② The preoperative stress response of beta endorphin, cortisol and angiotensin levels had no significant differences between the two groups（P〉0.05）, the index levels 1 d after operation in study group were lower than those in the control group, the differences were significant （P〈 0.05）;③Serum inflammatory factors： IL-6 and CRP levels had no statistically significant difference between the two groups before operation（P〉0.05）, the index levels in study group 1 d after operation were lower than that in the control group, the differences were significant （P〈 0.05）;④Pulmonary function： PEF, FEV1 and EVC levels had no significant difference between the two groups before surgery（P〉0.05）, every index in research group 1 d after operation was higher than that in the control group, but the differences were not significant （P〉0.05）, FEV1, EVC, PEF in the study group in study group 3 days after operation were significantly higher than those in control group, the differences were significant （P〈 0.05）;⑤Adverse reactions： the incidence of adverse reactions in the study group （13.15%） was lower than that in the control group （36.83%）, and the difference was significant （P〈 0.05）.Conclusions Intercostal nerve cryotherapy can relieve pain after thoracotomy, relieve the inflammatory response and stress response, improve the pulmonary function and safety.