胸腔镜手术后患者的镇痛方式及其研究进展

Patient 's Analgesic Methods after Thoracoscopic Surgery and Its Research Progress

目的随着胸腔镜下肺叶切除术的引入,该技术已逐渐发展为绝大多数肺切除术的常规手术。与传统开胸术式相比,电视胸腔镜手术有改善术后呼吸功能,减轻术后疼痛及缩短住院时长等优势。但胸腔镜术后引发的疼痛,其病理生理与开胸术后疼痛一样,都主要是因为手术切口和局部创伤,胸腔引流管的插入和肩膀疼痛综合征。手术引发的炎症应答和伤害性刺激都会出现,不会受手术方式影响。总之,胸腔镜术后疼痛仍然存在。术后疼痛会导致患者交感神经兴奋,出现心肌梗死、中风等高危并发症;术后疼痛常会限制患者深呼吸和有效咳嗽,不利于肺功能恢复且会增加肺部合并症的发生,从而延长住院时间;术后活动受限还会使血栓形成机率增高。因此,疼痛控制是促进胸腔镜术后患者快速康复的关键环节,及时有效的术后镇痛对患者至关重要,胸腔镜术后镇痛必不可少。

With the introduction of thoracoscopic lobectomy,this technique has gradually evolved into the routine operation of most pneumonectomy.Compared with the traditional thoracotomy,video-assisted thoracoscopic surgery can improve postoperative respiratory function,reduce postoperative pain and shorten hospital stay and other advantages.However,the pain caused by thoracoscopic surgery,its pathophysiology and post-thoracotomy pain,are mainly due to surgical incision and local trauma,chest drainage tube insertion and shoulder pain syndrome.Surgery-induced inflammatory response and noxious stimulation will appear,will not be affected by the surgical approach.In short,thoracoscopic pain remains.Postoperative pain will lead to sympathetic nerve stimulation,myocardial infarction,stroke and other high-risk complications;postoperative patients are often due to fear of pain and limit deep breathing and effective cough,is not conducive to lung function recovery and will increase the incidence of pulmonary complications,thus Prolong the length of hospital stay;limited postoperative activities will increase the risk of thrombosis.Therefore,pain control is to promote the rapid recovery of patients after thoracoscopic key link,timely and effective postoperative analgesia is crucial to the patient,thoracoscopic postoperative analgesia is essential.