精确肋间神经冷冻在老年患者胸腔镜手术中的初步应用  

Preliminary application of precision intercostal nerve cryoanalgesia in thoracoscopic surgery for elderly patients

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

机构地区：[1]解放军总医院胸外科,北京100853

出　　处：《中华保健医学杂志》2016年第2期120-122,共3页Chinese Journal of Health Care and Medicine

基　　金：北京市科学技术委员会首都市民健康项目培育(Z111100074911004)

摘　　要：目的观察精准肋间神经冷冻止痛术用于老年患者胸腔镜手术后镇痛的临床疗效。方法 2013年6月-2014年6月期间,于解放军总医院胸外科接受胸腔镜手术的老年患者60名,按随机数字表法随机分为2组,每组30例,肋间神经冷冻止痛组（A组）,术中施行精确解剖肋间神经分支冷冻止痛术,对照组施行术后自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）（B组）。术后根据视觉模拟疼痛评分（visual analogus scale,VAS）对疼痛进行评价,并观察记录术后肺部并发症的发生情况。结果术后第1、3、5、7天,A组术后疼痛评分均明显低于B组（P〈0.01）。术后A组、B组肺部并发症发生率都较低,两组对比差异无统计学意义。结论精准肋间神经冷冻止痛能有效缓解老年患者胸腔镜术后疼痛,并且在一定程度上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 effectiveness of precision intercostal nerve cryoanalgesia in thoracoscopic surgery for elderly patients. Methods Sixty patients were randomly assigned to 2 groups（n = 30）. In the cryoanalgesia group（group A）, intercostal nerves were frozen prior to chest closure for 90 seconds at-70°C. Intercostal nerves were not frozen in the control group patients（group B）. Following surgery, the degree of postoperative pain in all patients were evaluated with visual analogue scale 1, 3, 5,and 7 days after surgery. Postoperative complications were also recorded. Results The visual analogue scale scores, maintained for over 30 days, were significantly lower for patients in the cryoanalgesia group compared with those in the control group（P〈0.01）. Conclusion Freezing the intercostal nerve at-70 °C for 90 seconds is a safe and effective method for relieving post-thoracotomy pain.

关 键 词：肋间神经 精细解剖 冷冻止痛 老年 胸腔镜手术 

分 类 号：R655[医药卫生—外科学]