协和医学杂志

2011, v.2(01) 37-41

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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

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作者(Author): 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

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