肋间神经冷冻术对电视胸腔镜术后患者的镇痛效果及安全性  

Analgesic effect and safety of intercostal nerve cryoanalgesia after the video-assisted thoracoscopic surgery

作　　者：李永春[1] 许梅曦[1] 何瑶轩 叶胜泉 林洪胜 李富 李伟[1] 王军业[4] 

机构地区：[1]中山大学肿瘤防治中心麻醉科,广州530060 [2]深圳市宝安区沙井人民医院胸外科 [3]海南省农垦总医院胸外科 [4]中山大学肿瘤防治中心胸外科,广州530060

出　　处：《中华医学杂志》2015年第38期3138-3141,共4页National Medical Journal of China

基　　金：广东省科技计划（2014-116号）

摘　　要：目的 探讨肋间神经冷冻术应用于电视胸腔镜手术（VATS）后的镇痛效果及安全性.方法 该研究为前瞻性随机对照研究.选择2014年5月至2015年4月胸外科同一手术组并符合择期手术条件的患者80例,根据随机数字表法,将符合纳入标准的患者分为冷冻组和静脉组,每组40例.记录术后4h、1d、2d、3d的运动和静息视觉模拟评分（VAS）以及吗啡补充使用量、不良反应发生率.检测术前及术后4h、1d、2d血浆皮质醇、血糖、C-反应蛋白（CRP）及白细胞介素乇（IL-6）的血浆浓度.结果 71例患者完成全部试验过程并进行统计分析,其中冷冻组35例,静脉组36例,2组患者在年龄、性别、体质指数（BMI）等一般临床资料方面的差异均无统计学意义（均P＞0.05）.冷冻组运动VAS评分在术后4h、1d、2d、3d分别为5（5,7）、4（3,6）、3（3,4）、3（0,3）分,静脉组分别为5（5,6）、5（3,5）、3（3,4）、2（0,3）分,差异均无统计学意义（均P＞0.05）;冷冻组静息VAS评分在术后4h、1d、2d、3d分别为3（2,4）、0（0,3）、0（0,0）、0（0,0）分,静脉组分别为3（0.5,4）、2（0,3）、0（0,1.5）、0（0,0）分,差异均无统计学意义（均P＞0.05）.2组在术后4h、1d、2d吗啡使用量相同,冷冻组吗啡累积使用量高于静脉组,但2组间的差异无统计学意义（P＞0.05）;冷冻组、静脉组在静息时的镇痛有效率（VAS≤5分）分别为91.4％和97.2％;静脉组恶心、呕吐发生率为36.1％,明显高于冷冻组的17.1％ （x2 =4.148,P＜0.05）;血浆中皮质醇、CRP、IL-6的浓度在术后有比较明显的改变,但在各时间点的差异均无统计学意义.结论 VATS下肋间神经冷冻术的镇痛效果与静脉镇痛相同;相比静脉镇痛,冷冻组患者不良反应的发生率低,不增加应激反应.Objective To investigate the analgesic efficacy and safety of intercostal nerve cryoanalgesia after video-assisted thoracoscopic surgery （VATS）.Methods This was a prospective randomized controlled study.From May 2014 to April 2015,80 patients who would undergoing selective surgery performed by the same surgeon team were chosen,and were randomly divided into cryoanalgesia group and intravenous analgesia group by a random number table.Visual analogue scale （VAS） at resting and movement were measured on postoperative 4 h,1 d,2 d,3 d,and the amount of supplemental morphine use and adverse reactions were recorded;plasma concentration of cortisol,blood glucose,C-reactive protein （CRP） and intedeukin-6 （IL-6） were detected on preoperative and postoperative 4 h,1 d,2 d.Results Seventy-onepatients with complete test process were included in the statistical analysis,including cryoanalgesia group （35 cases） and intravenous group （36 cases）.No statistical differences were found in terms of age,gender,body mass index （BMI） between the two groups.VAS scores of cryoanalgesia group at movement on postoperative4h,1 d,2 d,3 d were 5（5,7）,4（3,6）,3（3,4）,3（0,3）,and in intravenous group were 5 （5,6）,5 （3,5）,3 （3,4）,2 （0,3）,respectively,but there was no statistically different between two groups （P 〉 0.05）.Resting VAS scores of cryoanalgesia group on postoperative 4 h,1 d,2 d,3 d were 3（2,4）,0（0,3）,0（0,0）,0（0,0）,and in intravenous group were 3（0.5,4）,2（0,3）,0 （0,1.5）,0 （0,0） respectively,but there was no statistically different between two groups （P 〉 0.05）.Resting analgesic effectiveness （VAS≤5） of cryoanalgesia group were 91.4%,and in intravenous group were 97.2%,respectively.Median of morphine dosage was equal between two groups on postoperative 4 h,1 d,2 d,cumulative amount of morphine of cryoanalgesia group was higher than intravenous group,but the difference between the two groups was not statistically significant.Inciden

关 键 词：肋间神经冷冻术 电视胸腔镜手术 静脉镇痛 应激反应 

分 类 号：R614[医药卫生—麻醉学]