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肋间神经冷冻治疗老年人开胸术后疼痛的临床研究

李明江,张卫东,王旭晖,李晓平,刘祥,闫冬梅   

  1. 天津市第一中心医院
  • 收稿日期:2013-04-17 修回日期:2013-09-11 出版日期:2014-01-15 发布日期:2014-01-15
  • 通讯作者: 张卫东

Clinical Study of Intercostal Cryoanalgesia in Post-thoracotomy Analgesia in Aged Patients

  • Received:2013-04-17 Revised:2013-09-11 Published:2014-01-15 Online:2014-01-15

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摘要： 目的 研究肋间神经冷冻治疗在老年患者开胸手术中的应用价值。方法 将190例行开胸手术的老年患者随机分为肋间神经冷冻止痛组 （A组） 91例和静脉镇痛泵组 （B组） 99例， 记录2组患者手术时间、 拔除胸管时间、 术后平均住院时间及杜冷丁用量， 采用Prince-Henry术后疼痛评分法评估患者疼痛程度， 比较2组术后心肺并发症、 不良反应、 慢性疼痛和麻木的发生率。结果 2组手术时间 （min： 85.7±27.3 vs 82.8±31.8） 差异无统计学意义， A组拔除胸管时间 （d： 3.8±3.1 vs 5.2±2.4）、 术后住院时间 （d： 10.8±5.3 vs 14.4±4.7） 及杜冷丁用量 （mg： 54±39 vs326±147） 均少于B组 （均P＜0.05）。除全麻清醒后3 h、 3 d 和7 d 2组Prince-Henry评分无差异外， A组Prince-Henry评分均低于B组 （均P＜0.05）。术后6、 24、 48 h A组p(O2)均高于B组， p(CO2)均低于B组 （均P＜0.05）。A组术后并发症 （6.6% vs19.2%， χ2=6.586）、 不良反应发生率 （0 vs 23.2%， χ2=24.053） 均低于B组 （均P＜0.05）。2组慢性疼痛、 麻木的发生率差异无统计学意义。结论 肋间神经冷冻治疗老年人开胸术后疼痛的效果优于静脉镇痛泵。

关键词: 肋间神经冷冻, 镇痛, 静脉镇痛泵, 老年人, 开胸术后

Abstract: Clinical Study of Intercostal Cryoanalgesia in Post-thoracotomy Analgesia in Aged Patients Mingjiang Li1, Weidong Zhang, Xuhui Wang, Xiaoping Li, Xiang Liu, Dongmei Yan Tianjin First Central Hospital Abstract Objective：The aim of this study was to investigate the value of intercostal cryoanalgesia in aged patients undergoing thoracotomy. Methods: 190 patients（age>60） were randomized into two groups: group A (cryoanalgesia group ,n = 91) and an group B (intravenous patient-controlled analgesia group,n = 99). Subjective pain intensity was assessed on a Prince-Henry score after operation. The intensity and the incidence of postoperation pain, the analgesic requirements, as well as the blood gas values and Chronic pain were evaluated and recorded. Results：In group A there was a statistically significant improvement in pain scores, reduction in consumption of pethidne, increase in values of partial pressure of oxygen (PaO2), reduction in the incidence of complications (P<0.05). There were no significant changes in operation time and chronic pain and numbness (P > 0.05). Conclusion: Intercostal nerve cryoanalgesia could effectively relief the postoperative pain, promote postoperative recovery in elderly patients and should be commonly used.

Key words: intercostal cryoanalgesia, analgesia, intravenous patient-controlled analgesia, aged, post-thoracotomy