胸腔镜肋间神经阻滞对胸腺切除术后镇痛效果的影响  

Effects of thoracoscopic intercostal nerve block for postoperative analgesia after thymectomy

作　　者：柯冀[1] 佟凡 崔健 马波波 于磊[1] Ke Ji;Tong Fan;Cui Jian;Ma Bobo;Yu Lei(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of General Surgery,Chuiyangliu Hospital Affiliated to Tsinghua University,Beijing 100022,China;Department of General Surgery,China Rehabilitation Research Center,School of Rehabilitation Medicine,Capital Medical University,Beijing 100068,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730 [2]清华大学附属垂杨柳医院普外科,北京100022 [3]首都医科大学康复医学院中国康复研究中心普外科,北京100068

出　　处：《中国医刊》2022年第7期758-762,共5页Chinese Journal of Medicine

摘　　要：目的探讨胸腔镜肋间神经阻滞对胸腺切除术后镇痛效果的影响。方法选取2019年7月至2021年6月在首都医科大学附属北京同仁医院行胸腔镜胸腺切除术的患者90例,根据术后镇痛方式的不同分为A、B、C三组,每组30例。其中A组仅于术后给予静脉镇痛泵镇痛,B组和C组分别于术中在胸腔镜下给予0.375%及0.5%罗哌卡因进行肋间神经阻滞,然后于术后给予静脉镇痛泵镇痛。比较三组患者术后6、12、18、24h的疼痛视觉模拟量表(visual analogue scale,VAS)评分和Prince-Henry疼痛量表(Prince Henry pain scale,PHPS)评分,术后镇痛泵按压次数和追加镇痛药物次数,以及镇痛药物相关不良反应发生情况。结果术后6、12h,A组的VAS评分明显高于B、C组,且B组明显高于C组,术后24h,A组VAS评分明显低于C组,差异均有显著性(P<0.05)。术后6h,A组的PHPS评分明显高于B、C组,术后12h,A组的PHPS评分明显高于B、C组,且B组明显高于C组,差异均有显著性(P<0.05)。A组术后镇痛泵按压次数明显高于B、C组,差异有显著性(P<0.05),而B组与C组比较差异无显著性(P>0.05)。A组术后追加镇痛药物次数明显高于B、C组,且B组明显高于C组,差异均有显著性(P<0.05)。C组恶心、呕吐、头晕等镇痛药物相关不良反应发生率明显低于A组,差异有显著性(P<0.05)。结论静脉镇痛泵联合胸腔镜肋间神经阻滞对胸腺切除术后的镇痛效果明显优于单纯静脉镇痛泵镇痛,操作简单、安全,并可减少术后镇痛药物的使用,减轻药物不良反应,值得临床应用。Objective To investigate the effect of thoracoscopic intercostal nerve block for analgesia after thymectomy.Method A total of 90 patients who underwent thoracoscopic thymectomy in Beijing Tongren Hospital Affiliated to Capital Medical University from July 2019 to June 2021 were selected and divided into 3 groups A,B,and C.Among them,group A only received patient controlled intravenous analgesia(PCIA)after surgery.Group B and C were given 0.375%and 0.5%ropivacaine for intercostal nerve block(INB)by thoracoscopy,respectively.And then given PCIA after surgery.The pain visual analogue scale(VAS)score and the Prince Henry pain scale(PHPS)score were evaluated for each groups at 6,12,18,and 24 hours after the surgery.The additional PCIA press,and analgesic drugs use were recorded,and the adverse reaction of drugs.Result The VAS score of group A was significantly higher than group B and C,meanwhile group B was significantly higher than group C at the time of 6 and 12 hours after surgery(P<0.05).At the point of 24 hours after surgery,the VAS score of group A was significantly lower than that of group C(P<0.05).The PHPS score of group A was significantly higher than groups B and C at the time of 6 hours after surgery(P<0.05).At the point of 12 hours after surgery,the PHPS score of group A was significantly higher than that of groups B and C,meanwhile group B was significantly higher than group C(P<0.05).The frequency of press on PCIA in group A was significantly higher than that in groups B and C(P<0.05),while there was no significant difference between group B and group C(P>0.05).The additional use of analgesic drugs in group A was also significantly higher than that in groups B and C,while group B was significantly higher than group C(P<0.05).The incidence of analgesic-related adverse reactions such as nausea,vomiting and dizziness in group C was significantly lower than that in group A(P<0.05).Conclusion Combined thoracoscopic INB with PCIA is more effective than PCIA in pain control after thymectomy,and the operation o

关 键 词：胸腺切除术 肋间神经阻滞 胸腔镜 术后镇痛 

分 类 号：R655.7[医药卫生—外科学]