肋间神经冷冻术与自控镇痛对开胸术后早期镇痛效果的比较Comparison of Intercostal Nerve Cryoanalgesia and Patient-controlled Analgesia for Early Post-thoracotomy Pain Control
梁乃新;张帆;黄诚;秦应之;刘洪生;李单青;
LIANG Nai-xin,ZHANG Fan,HUANG Cheng,QIN Ying-zhi,LIU Hong-sheng,LI Shan-qing Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China
摘要(Abstract):
目的比较开胸术后早期3种新镇痛方法的疗效,探求最佳镇痛方案。方法 81例开胸术后患者,随机分为3组,分别采用患者自控镇痛静脉给药(patient controlled intravenous analgesia,PCIA)、患者自控硬膜外给药(pa-tient controlled epidural analgesia,PCEA)及肋间神经冷冻术(intercostal nerve cryoanalgesia,INC)镇痛,根据视觉模拟评分法(visual analogue scales,VAS)进行手术日及术后3日疼痛评分,同时用量表对3种镇痛方法的不良反应进行评价。结果 PCEA组与PCIA组比较,所用镇痛药剂量差异无统计学意义(P>0.05),但用药次数明显减少(P<0.01);VAS评分示PCEA组镇痛效果明显优于PCIA和INC组(P<0.01)。术后第2、3天PCEA组较INC组自行排痰能力显著提高(P<0.01),PCIA组亦较INC组明显提高(P<0.05)。PCIA组的不良反应显著高于PCEA和INC组(P<0.01),INC组不良反应显著低于PCIA和PCEA组(P<0.01)。综合评估指标显示PCEA组显著优于PCIA和INC组(P<0.01)。结论开胸术后早期PCEA的镇痛效果最好,不良反应较低,患者排痰能力最强,综合评价最高,是3种镇痛方法中的最佳选择。
Objective To compare the effectiveness of three new analgesia methods for early post-thoracotomy pain control.Methods Totally 81 patients randomly accepted one of three new methods for post-thoracotomy analgesia:patient controlled intravenous analgesia(PCIA),patient controlled epidural analgesia(PCEA),and intercostal nerve cryoanalgesia(INC).The effects were evaluated by visual analogue scales(VAS)from the day of thoracotomy to 3 days after operation.Results The dosage was not significantly different between PCEA and PCIA groups(P>0.05),but PCEA group had significantly less administration frequency(P<0.05).The VAS score was significantly superior in PCEA group than in the other two groups(P<0.01).The expectoration ability was significantly better in PCEA group than in INC groups(P<0.01),and was significantly better in PCIA group than in INC group(P<0.05)in the second and the third post-thoracotomy days.The incidence of side effects was significantly higher in PCIA group than in PCEA and INC groups(P<0.01),and was significantly lower in INC group than in the other two groups(P<0.01).The integrated evaluations showed that PCEA group was significantly better than the other two groups(P<0.01).Conclusions PCEA has better analgesic effect than PCIA and INC for post-thoracotomy pain control,lower incidence of side effects,and better expectoration ability.Thus,PCEA is the most suitable method for controlling the early post-thoracotomy pain.
关键词(KeyWords):
开胸术;开胸术后疼痛;肋间神经冷冻术;自控镇痛;视觉模拟评分
thoracotomy;post-thoracotomy pain;intercostal nerve cryoanalgesia;patient controlled analgesia;visual analogue scales
基金项目(Foundation):
作者(Authors):
梁乃新;张帆;黄诚;秦应之;刘洪生;李单青;
LIANG Nai-xin,ZHANG Fan,HUANG Cheng,QIN Ying-zhi,LIU Hong-sheng,LI Shan-qing Department of Thoracic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China
参考文献(References):
- [1]Yao YH,Ning X,Zhang P,et al.Comparison of the effica-cy of cryoanalgesia and patient-controlled analgesia after tho-racotomy[J].J First Mil Med Univ,2005,25:469-470,473.
- [2]Moorjani N,Zhao F,Tian Y,et al.Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostal nerves:a human prospective randomized trial and a histolog-ical study[J].Eur J Cardiothorac Surg,2001,20:502-507.
- [3]Brichon PY,Pison C,Chaffanjon P,et al.Comparison of epidural analgesia and cryoanalgesia in thoracic surgery[J].Eur J Cardiothorac Surg,1994,8:482-486.
- [4]Richardson J,Sabanathan S,Shah R.Post-thoracotomy spi-rometric lung function:the effect of analgesia[J].J Card-iovasc Surg(Torino),1999,40:445-456.
- [5]De Cosmo G,Aceto P,Gualtieri E,et al.Analgesia in tho-racic surgery:review[J].Minerva Anestesiol,2009,75:393-400.
- [6]Tovar EA,Roethe RA,Weissig MD,et al.Muscle-sparing minithoracotomy with intercostal nerve cryoanalgesia:an im-proved method for major lung resections[J].Am Surg,1998,64:1109-1115.
- [7]Ju H,Feng Y,Yang BX,et al.Comparison of epidural an-algesia and intercostal nerve cryoanalgesia for post thoracoto-my pain control[J].Eur J Pain,2008,12:378-384.
- [8]Green CR,de Rosayro AM,Tait AR.The role of cryoanal-gesia for chronic thoracic pain:results of a long-term follow up[J].J Natl Med Assoc,2002,94:716-720.
- [9]Detterbeck FC.Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy[J].Ann ThoracSurg,2005,80:1550-1559.
- [10]Becker M.Cost-effectiveness of peridural and intravenous analgesic schemes[J].Anasthesiol Intensivmed Notfallmed Schmerzther,2010,45:168-169.
- [11]Lavand homme P,Roelants F.Patient-controlled intrave-nous analgesia as an alternative to epidural analgesia during labor:questioning the use of the short-acting opioid remifen-tanil[J].Acta Anaesthesiol Belg,2009,60:75-82.
- 开胸术
- 开胸术后疼痛
- 肋间神经冷冻术
- 自控镇痛
- 视觉模拟评分
thoracotomy - post-thoracotomy pain
- intercostal nerve cryoanalgesia
- patient controlled analgesia
- visual analogue scales
- 梁乃新
- 张帆
- 黄诚
- 秦应之
- 刘洪生
- 李单青
LIANG Nai-xin- ZHANG Fan
- HUANG Cheng
- QIN Ying-zhi
- LIU Hong-sheng
- LI Shan-qing Department of Thoracic Surgery
- Peking Union Medical College Hospital
- Chinese Academy of Medical Science & Peking Union Medical College
- Beijing 100730
- China
- 梁乃新
- 张帆
- 黄诚
- 秦应之
- 刘洪生
- 李单青
LIANG Nai-xin- ZHANG Fan
- HUANG Cheng
- QIN Ying-zhi
- LIU Hong-sheng
- LI Shan-qing Department of Thoracic Surgery
- Peking Union Medical College Hospital
- Chinese Academy of Medical Science & Peking Union Medical College
- Beijing 100730
- China