两种不同镇痛方法对开胸手术术后恢复的影响

目的:比较经静脉自控镇痛、肋间神经冷冻术两种镇痛方法对开胸手术患者术后恢复的影响。方法:60例开胸手术患者随机分为肋间神经冷冻组(INC组)和患者静脉自控镇痛组(PCA组)。疼痛强度评分法(NRS)评估术后疼痛程度。结果:(1)两组比较,术后并发症、下床时间、正常活动时间差异无统计学意义(P>0.05)。而术后副反应比较,PCA组较INC组严重(P<0.05);INC组较PCA组术后胸引管引流量大,胸引管拔除时间长(均P<0.05)。INC组术后肺功能恢复明显好于PCA组(P<0.05)。(2)术后前2d内,疼痛指数及镇痛药物使用方面两组差异无统计学意义(P>0.05);术后第3～7天,INC组较PCA组疼痛明显减轻(P<0.05),但药物使用方面差异无统计学意义(P>0.05)。结论:肋间神经冷冻术是比较好的胸部手术术后镇痛治疗方法,副作用小,但术后胸引管引流量增加,拔除胸引管时间延长。

Effects of two kinds of analgesia methods on the postoperative recovery of patients receiving thoracotomy

Objective To compare the effects of intravenous analgesia with intercostal nerve cryotherapy on postoperative recovery in patients receiving thoracotomy. Methods Sixty patients undergoing thoracic surgery were randomly divided into 2 groups (each n = 30): intercostal nerve freezing group (INC group) and patient-controlled intravenous analgesia group (PCA group). The degree of pain was assessed by numeric pain intensity score (NRS). The adverse reaction was recorded also. Results Postoperative complications, ambulation time, and time to normal activity were not significantly different between the two groups (P > 0.05). The postoperative side effects in PCA group were severer than those in INC group (P < 0.05). The chest tube drainage was higher and chest tube remove time was longer in INC group than those in PCA group (P < 0.05). Pain scores and analgesic drug using in the first two days after surgery were not significantly different between the two groups (P > 0.05). The pain score was significantly decreased in INC group than that in PCA group in 3 ～ 7 days after surgery (P < 0.05), but the analgesic drug using between the two groups had no significant difference (P > 0.05). Conclusions Intercostal nerve freezing technique is a better analgesia method after thoracic surgery treatment with fewer side effects, but the chest tube drainage was increased and the time to remove the chest tube was longer.