开胸术后持续肋间神经阻滞镇痛效果的临床研究  

Clinical study of pain control with continuous intercostal nerve block after thoracotomy

作　　者：刘铮 朱宏[1] 任杰[1] 刘文[1] 杨艳刚[1] 张林[1] 杨威[1] 张永洪[2] 罗继文[1] LIU Zheng;ZHU Hong;REN Jie;LIU Wen;YANG Yangang;ZHANG Lin;YANG Wei;ZHANG Yonghong;LUO Jiwen(Department of Cardiothoracic Surgery,Mianyang Central Hospital,621000,Sichuan,P.R.China;Department of Anesthesiology,Mianyang Central Hospital,621000,Sichuan,P.R.China)

机构地区：[1]绵阳市中心医院心胸外科,四川绵阳621000 [2]绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《中国胸心血管外科临床杂志》2020年第7期784-788,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：绵阳市卫生计划生育委员会资助项目(201758)。

摘　　要：目的评价开胸术后持续肋间神经阻滞的镇痛效果。方法纳入2017年11月至2018年10月于我院进行开胸手术的120例患者,其中男60例、女60例,年龄40~77(58.10±7.00)岁。按照入院先后顺序,采用随机数表产生随机序列分成三组,各组在基础镇痛(阿片类联合非甾体消炎镇痛药)方案上,根据联合镇痛方案不同,分为持续肋间神经阻滞组(A组,n=40)、单纯肋间神经阻滞组(B组,n=40)及持续硬膜外镇痛组(C组,n=40),比较各组术后疼痛程度及追加镇痛药物的差异。结果术后第0 d,三组方案联合基础镇痛均能有效控制疼痛,视觉模拟疼痛评分A组(2.02±0.39)分,B组(2.13±0.75)分,C组(2.03±0.69)分,组间差异无统计学意义(P>0.05)。术后第0~2 d与术后第3~4 d(停止基础镇痛),A组与C组患者疼痛评分差异无统计学意义[(2.08±0.28)分vs.(1.93±0.53)分,(3.20±0.53)分vs.(3.46±0.47)分,P>0.05]。术后第0~2 d与术后第3~4 d相比,各组内疼痛评分差异有统计学意义[A组(2.08±0.28)分vs.(3.20±0.53)分,B组(2.42±0.73)分vs.(5.45±0.99)分,C组(1.93±0.53)分vs.(3.46±0.47)分,P<0.05]。追加镇痛药物剂量A组与C组差异无统计学意义[(220.00±64.08)mg vs.(225.38±78.85)mg,P>0.05],B组高于A组和C组[(343.33±119.56)mg vs.(220.00±64.08)mg,(343.33±119.56)mg vs.(225.38±78.85)mg,P<0.05]。结论多模式镇痛是开胸术后早期控制疼痛的理想方案。持续肋间神经阻滞可有效减轻患者术后疼痛。Objective To determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.Methods From November 2017 to October 2018,120 patients who received thoracotomy procedure in our hospital were collected,including 60 males and 60 females aged 40-77(58.10±7.00)years.The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group(group A,n=40),a single intercostal nerve block group(group B,n=40),and an epidural analgesia group(group C,n=40).All the groups received the same basic analgesia.The pain scores and rescue analgesic doses were compared.Results On postoperative day(POD)0,all groups achieved effective pain control,and the visual analogue score was 2.02±0.39 points in the group A,2.13±0.75 points in the group B and 2.03±0.69 points in the group C(P>0.05).On POD 0-2 and POD 3-4(without basement analgesia),there was no significant difference between the group A and group C in the pain scores(2.08±0.28 points vs.1.93±0.53 points,3.20±0.53 points vs.3.46±0.47 points,P>0.05),however,the difference between POD 0-2 and POD 3-4 in each group was stastically different(group A,2.08±0.28 points vs.3.20±0.53 points;group B,2.42±0.73 points vs.5.45±0.99 points;group C 1.93±0.53 points vs.3.46±0.47 points,P<0.05).In terms of the rescue analgesic doses,there was no significant difference between the group A and group C(220.00±64.08 mg vs.225.38±78.85 mg,P>0.05);it was larger in the group B than that in the group A and group C(343.33±119.56 mg vs.220.00±64.08 mg;343.33±119.56 mg vs.225.38±78.85 mg,P<0.05).Conclusion Multimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery.Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.

关 键 词：持续肋间神经阻滞 开胸手术 多模式镇痛 治疗 

分 类 号：R614[医药卫生—麻醉学]