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作 者:白艳艳[1] 张立娜[1] 毛宇[2] 解雅英[3] BAI Yan-yan;ZHANG Li-na;MAO Yu(Department of Anesthesiology,Hohhot First Hospital,Hohhot Inner Mongolia 010035,China;Department of Thoracic Surgery,Hohhot First Hospital,Hohhot Inner Mongolia,010035,China)
机构地区:[1]呼和浩特市第一医院麻醉科,内蒙古呼和浩特010035 [2]呼和浩特市第一医院胸外科,内蒙古呼和浩特010035 [3]内蒙古医科大学附属医院麻醉科,内蒙古呼和浩特010035
出 处:《临床和实验医学杂志》2020年第21期2322-2325,共4页Journal of Clinical and Experimental Medicine
基 金:内蒙古科技厅计划项目(编号:201702145);呼和浩特市科技计划项目(编号:2017-社-1-2)。
摘 要:目的探讨单次注射椎旁阻滞、椎旁导管和胸椎硬膜外导管镇痛对单侧胸腔镜手术患者术后疼痛的影响。方法前瞻性选取86例全麻下进行单侧胸腔镜手术患者作为研究对象,将患者按数字表法随机分为3组,即单次注射椎旁阻滞(A组,n=25)、椎旁导管(B组,n=28)和胸椎硬膜外导管组(C组,n=23)。于手术前、手术后1周、2周和1个月观察比较3组患者视觉模拟(VAS)评分、疼痛总分(PRI)与疼痛强度(PPI)以及术后采取自控镇痛、镇痛药情况及疼痛阈值。结果3组患者在术后VAS评分、治疗后疼痛总分与疼痛强度以及术后采取自控镇痛、止痛药情况、疼痛阈值以及短期认知功能之间均存在显著差异(P<0.01)。其中,随着手术时间延长,患者的VAS评分、PRI和PPI值均出现下降趋势,C组患者PRI和PPI值在各阶段值均最低且能够自控镇痛,不存在使用止痛药的现象,A组和B组患者则需要通过辅助不同剂量镇痛药进行镇痛。另外,C组患者疼痛阈值最高。结论单次注射椎旁阻滞、椎旁导管和胸椎硬膜外导管镇痛方法均能明显减轻胸腔镜手术患者术后疼痛程度,其中硬膜外镇痛组患者术后疼痛阈值最高。Objective To investigate the change of pain threshold in thoracoscopic surgery with single injection of paravertebral block,paravertebral catheter and thoracic epidural catheter.Methods 86 patients with unilateral thoracoscope surgery under general anesthesia were selected as the object of study prospectively,they were divided into three groups,namely single injection of vertebral side block(group A,n=25),vertebral side catheter(group B,n=28)and thoracic epidural catheter(group C,n=23),compare the three groups of patients with pain VAS score,total pain score(PRI)and pain intensity(PPI)and take self-control analgesia,painkillers,observed in patients with pain threshold.Results There were significant differences between the three groups in VAS score,total post-treatment pain score and pain intensity,as well as postoperative self-controlled analgesia,analgesic status,pain threshold and short-term cognitive function(P<0.01).Among them,VAS score,PRI and PPI all showed a downward trend with the extension of treatment time.Patients in group C had the lowest PRI and PPI values at all stages and were able to control analgesia without the use of painkillers.Patients in group A and B needed to use painkillers for analgesia.In addition,patients in group C had the highest pain threshold.Conclusion Compared with single injection of paravertebral block and paravertebral catheter,thoracoscopic surgery with epidural catheter of thoracic vertebra has a great influence on postoperative pain threshold of patients undergoing thoracoscopic surgery,and the most significant effect is that it can significantly reduce postoperative pain degree of patients.
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