精准肋间神经冷冻止痛在胸腔镜纵隔肿瘤切除术中的初步应用  

Clinical efficacy of intercostal nerve cryoanalgesia based on accurate anatomy for mediastinal tumor resection pain relief with video-assisted thoracoscopic surgery

作　　者：马永富[1] 褚剑[1] 刘阳[1] 李捷[1] 张涛[1] 郭俊唐[1] 梁朝阳[1] 李敏[1] 

机构地区：[1]中国人民解放军总医院胸外科,北京100039

出　　处：《中国肿瘤临床与康复》2014年第6期682-684,共3页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：北京市科学技术委员会首都市民健康项目培育;课题编号:Z111100074911004

摘　　要：目的探讨精准肋间神经冷冻止痛在胸腔镜纵隔肿瘤切除术中的效果。方法选取2011年1月至2014年1月间行胸腔镜纵隔肿瘤切除术患者60例,随机分为试验组和对照组,每组30例。试验组患者术中施行精准解剖肋间神经分支冷冻止痛,对照组患者施行术后自控静脉镇痛(PCIA)。术后观察记录镇痛药物用量、疼痛评分(VAS)及术后并发症的发生情况。结果试验组患者术后镇痛药物用量、疼痛评分及并发症发生率均明显低于对照组,差异有统计学意义(P<0.01)。结论精准肋间神经冷冻止痛能有效缓解患者术后疼痛,并且能够减少术后并发症的发生,是一种安全有效的止痛方法。Objective To evaluate the clinical efficacy of intercostal nerve cryoanalgesia based on accurate anatomy for mediastinal tumor resection pain relief. Methods 60 patients were randomly assigned to 2 groups （ n = 30）. In the cryoanalgesia group, the intercostal nerves were frozen prior to chest closure, and 2 costal nerves （ above and below incision） were frozen for 90 seconds at -70℃, respectively. Intercostal nerves were not frozen in the control group patients. Dolantin was used to relieve postoperative pain in patients from both groups. Following surgery, the degree of postoperative pain in all patients was evaluated by visual analogue scale at days 2,4,6,8, Dolantin doses at days 2,4,6,8 post-surgery and postoperative complications were noted. Results The visual analogue scale scores were significantly less in the cryoanalgesia group compared with the control group （P 〈 0. 01 ） o In the cryoanalgesia group, the mean dolantin dose administered and postoperative complications were significantly reduced compared with the control group （P 〈 0. 01 ）. Conclusion Freezing of the intercostal nerve at -70℃ for 90 seconds is a safe and long-term effective method for relieving post-thoracotomy pain.

关 键 词：肋间神经 精细解剖 冷冻止痛 纵隔肿瘤 胸腔镜手术 

分 类 号：R734.5[医药卫生—肿瘤]