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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

    摘要
  • 摘要:
      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(patient 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。

     

    Abstract:
      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.

     

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