肋间神经钳夹与布比卡因神经阻滞防治开胸术后疼痛的对比研究

目的探讨钳夹肋间神经在防治开胸术后切口疼痛的临床价值.方法对80例后外侧开胸手术的患者随机分研究组和对照组各40例.研究组患者关胸前钳夹切口、切口上下各一肋间及放置引流管的肋间神经根部.对照组患者关胸前用0.5%布比卡因行切口上下各2个肋间和引流口上下各1个肋间的神经阻滞.根据Logas疼痛评分法观察术后切口疼痛程度,记录使用哌替啶针的用量.术后随访3～6个月.结果两组术后第1周止痛效果和哌替啶针的用量相似,第2和第3周研究组止痛效果明显优于对照组,哌替啶针的用量明显少于对照组,两组差异有统计学意义（P＜0.05）.研究组术后止痛持续平均时间和感觉恢复正常平均时间较对照组延长（P＜0.05）.随诊3～6个月,两组切口处感觉无明显差别.结论钳夹肋间神经止痛能更持久、有效地防治开胸术后切口疼痛.

Comparison of analgesic effect between intercostals nerve crush and nerve blockade on post- thoracotomy pain

Objective To evaluate the analgesic effect of intercostals nerve crush after thoracotomy. Methods Eighty patients who had undergone thoracotomy were divided into two groups randomly. 40 were in study group and 4 routes of costal nerves were dissected and squeezed with forceps. 40 were in control group and intercostals nerves were blocked byusing 0.5% bupivacaine. Results Analgesic effect in the first week after operation wassimilar in two groups, but in the second and third week, analgesic effect in study group wasmuch better than in control group(P < 0.05). The duration of analgesic effect in study Groupwas longer than in control Group. Conclusion The intercostals nerve crush is an availableand lasting analgesic method to relieve postoperative pain of thoracotomy.