两种不同手术方式对肺癌患者术后急性疼痛的影响  

Effects of surgical method on postoperative acute pain scores in patients with lung cancer:a comparison between video-assisted thoracoscopic surgery and thoracotomy

作　　者：邱郁薇[1] 吴镜湘[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200030

出　　处：《上海医学》2013年第10期872-875,共4页Shanghai Medical Journal

基　　金：上海市级医院适宜技术联合开发推广应用项目资助(SHDC12010222)

摘　　要：目的观察电视胸腔镜与常规开胸手术对肺癌根治术患者术后急性期疼痛的影响。方法选取2011年1—8月择期行肺癌根治术的患者,根据手术方式分为电视胸腔镜下行肺癌根治术组(胸腔镜组,208例)和常规开胸手术下行肺癌根治术组(开放手术组,247例)。两组患者术中均行全凭静脉麻醉,术毕经颈内静脉留置导管行患者静脉自控镇痛(PCIA),药物总量为100mL,配方为芬太尼15~20μg/kg+氟比洛芬酯200mg+雷莫司琼0.6mg,以0.9%氯化钠溶液加至100mL。基础静脉输注速率为2mL/h,追加剂量为0.5mL,锁定时间为15min。观察并比较患者术后24和48h卧床静息自然呼吸状态(静息状态)和用力咳嗽(咳嗽状态)下的疼痛视觉模拟评分(VAS评分),并进行疼痛VAS评分分级:0分为无痛,1~3分为轻度疼痛,4~6分为中度疼痛,7~10分为重度疼痛。结果两组间在术后24、48h时静息状态下的疼痛VAS评分的差异均无统计学意义(P值均>0.05),而胸腔镜组术后48h时在咳嗽状态下的疼痛VAS评分显著低于开放手术组(P<0.05)。两组间术后24和48h时静息状态下的疼痛VAS评分分级中无痛、轻度疼痛、中度疼痛、重度疼痛的构成比的差异均无统计学意义(P值均>0.05);胸腔镜组术后24、48h时咳嗽状态下的重度疼痛构成比均显著低于开放手术组(P值均<0.05),术后24h时咳嗽状态下的中度疼痛构成比显著高于开放手术组(P<0.05)。结论与常规开胸手术下行肺癌根治术比较,电视胸腔镜下行肺癌根治术后患者在急性期用力咳嗽下疼痛VAS评分和重度疼痛的发生率降低,但静息状态下疼痛程度无明显改善,经PCIA后部分患者仍存在中、重度疼痛,因此重新评估并制定更为优越的镇痛方案尤为重要。Objective To compare the postoperative acute pain scores between video-assisted thoracoscopic surgery （VATS） and thoracotomy for lung cancer. Methods Between January 2011 and August 2011, patients scheduled for radical operation of lung cancer were assigned to two groups= VATS group （n--208） and thoracotomy group （ n -- 247）. All patients received total intravenous anesthesia and patient-controlled intravenous analgesia （PCIA）. Fentanyl 15- 20 μg/kg, flurbiprofen axetil 200 mg and ramosetron 0. 6 mg （dissolved in 100 mL of normal saline） were used in postoperative PCIA. Basic infusion rate was 2 mL/h, bolus dose was 0.5 mL and lockout time was 15 minutes. Visual analogue scale （VAS） scores at rest and coughing were compared at 24 hours and 48 hours after surgery between two groups. Pain scale was categorized into 4 categories= no pain （VAS 0）, mild pain （VAS 1 -3）, moderate pain （VAS 4-6） and severe pain （VAS 7- 10）. Results There was no significant difference in VAS at rest between two groups at 24 hours or 48 hours after surgery （all P〈〉0.05） ~ neither were in populational distribution of pain category at rest 24 hours or 48 hours after surgery between two groups （all P〉0.05）. VAS at coughing in VATS group was significantly lower than that in thoracotomy group at 48 hours after surgery （ P〈0.05）. Populational distribution of moderate pain and severe pain at coughing 24 hours after surgery and populational distribution of severe pain at coughing 48 hours after surgerywere significantly lower than that in thoracotomy group （all P^0. 05）. Conclusion Video-assisted thoracic surgery can significantly reduce postoperative acute pain at coughing and the incidence of severe pain as compared with thoracotomy. In some patients under VATS, PCIA can not provide adequate analgesia for cough-evoked pain, so re-evaluation of analgesia strategy is important for VATS.

关 键 词：电视胸腔镜手术 急性疼痛 急性疼痛管理 

分 类 号：R614[医药卫生—麻醉学]