针刀联合静脉自控镇痛对胸腔镜术后严重疼痛的影响

Effect of acupotomy combined with intravenous controlled analgesia on severe pain after VATS

目的探讨针刀联合静脉自控镇痛对电视辅助胸腔镜手术(VATS)后严重疼痛患者临床疗效。方法选取我院胸外科接受VATS术后第1天出现严重疼痛(VAS≥7)的患者84例为研究对象,随机分为对照组(单纯静脉自控镇痛)和治疗组(针刀加静脉自控镇痛)各42例。分别记录两组患者:治疗前0.5 h,治疗后0 h、24 h、48 h、72 h、1周的咳嗽状态下疼痛视觉模拟评分(VAS);治疗前0.5 h,治疗后0 h、24 h、1周的术后舒适度评分(BCS);并记录两组治疗前后的患侧上肢上举活动度。最终数据作统计分析,以评估疗效。结果干预周期结束后,两组患者治疗后VAS评分均明显低于治疗前,且治疗组在各时间点的下降幅度明显大于对照组(P<0.05);两组患者治疗后BCS评分均明显高于治疗前,且治疗组在各时间点的上升幅度明显大于对照组(P<0.05);治疗组患侧上肢上举活动度改善幅度明显大于对照组(P<0.05)。结论针刀联合静脉自控镇痛疗法可有效缓解VATS术后疼痛,改善患者术后舒适度,提高患侧上肢上举活动度,加快术后康复,适合临床推广使用。

Objective To investigate the clinical efficacy of acupotomy combined with patient-controlled intravenous analgesia in patients with severe pain after video-assisted thoracic surgery(VATS).Methods A total of 84 patients with severe pain(VAS≥7)on the first day after VATS in the Thoracic Surgery Department of Fujian Provincial Hospital were selected as the research objects and randomly divided into the control group(patient-controlled intravenous analgesia)and the treatment group(acupotomy combined with patient-controlled intravenous analgesia)with 42 cases in each group.The visual analogue scale(VAS)of pain in the cough state of the two groups of patients was recorded at 0.5 h before treatment,0 h,24 h,48 h,72 h,and 1 week after treatment;Bruggrmann comfort scale(BCS)was recorded at 0.5 h before treatment,0 h,24 h,1 week after treatment;and the range of motion of the upper limb on the affected side before and after treatment in the two groups was recorded.The final data were subjected to statistical analysis to assess efficacy.Results After the intervention period,the VAS scores of the two groups of patients after treatment were significantly lower than those before treatment,and the decrease in the treatment group at each time point was significantly greater than that in the control group(P<0.05);the BCS scores of the two groups of patients after treatment were significantly higher than those before treatment,and the increase in the treatment group at each time point was significantly greater than that in the control group(P<0.05);the improvement in the range of motion of the upper limbs on the affected side in the treatment group was significantly greater than that in the control group(P<0.05).Conclusion Acupotomy combined with patient-controlled intravenous analgesia can effectively relieve postoperative pain after VATS,improve postoperative comfort,improve the range of motion of the upper limb on the affected side,and speed up postoperative rehabilitation,which is suitable for clinical application.