术中直视下肋间神经阻滞与术后针刺镇痛在胸腔镜手术后镇痛的效果比较  

Comparison of Analgesic Effects of Intercostal Nerve Block under Direct Visualization During Surgery and Acupuncture Analgesia after Thoracoscopy Surgery

作　　者：王岳峰[1] 肖瑶 姜长林[1] 杨雪峰[1] WANG Yuefeng;XIAO Yao;JIANG Changlin;YANG Xuefeng(Department of Thoracic Surgery,Daqing Oilfield General Hospital,Daqing,Heilongjiang 163001,China)

机构地区：[1]大庆油田总医院胸外科,黑龙江大庆163001

出　　处：《临床误诊误治》2025年第6期49-54,共6页Clinical Misdiagnosis & Mistherapy

基　　金：大庆市指导性科技计划项目(zdy-2023-85);黑龙江卫生健康委科研课题(2019364)。

摘　　要：目的对比术中直视下肋间神经阻滞以及术后针刺镇痛用于胸腔镜手术后镇痛的效果。方法收集2023年7月至2024年6月行胸腔镜治疗的肺结节患者64例,按随机数字表法分为A组和B组各32例。A组给予术中直视下肋间神经阻滞镇痛,B组给予术后针刺镇痛。比较2组术后视觉模拟评分法(VAS)评分、主观镇痛满意度评分、首次下床活动时间、术后炎症指标和相关不良事件发生情况。结果术后6、12 h,A组VAS评分低于B组(P<0.05);术后36、72 h时,A组VAS评分高于B组(P<0.05)。2组住院期间抢救镇痛率、术后住院时间及术后不良事件发生率比较差异无统计学意义(P>0.05)。A组首次下床活动时间[(22.38±5.67)d]短于B组[(30.16±6.23)d],差异有统计学意义(P<0.01)。术后第1天,A组满意度评分高于B组,而术后第3天和第7天,A组满意度评分低于B组(P<0.05)。术后第3天,B组C反应蛋白和白细胞计数显著低于A组(P<0.05)。结论2种镇痛方式在胸腔镜手术后均具有较好镇痛效果,早期术中直视下肋间神经阻滞的疼痛控制效果优于针刺镇痛,随着时间推移针刺镇痛效果逐渐优于术中直视下肋间神经阻滞,2种方法的不良事件发生率均较低。Objective To compare the efficacy of intercostal nerve block(ICNB)under direct visualization during surgery with postoperative acupuncture analgesia for pain management after thoracoscopic surgery.Methods A total of 64 patients with pulmonary nodules who underwent thoracoscopic procedures between July 2023 and June 2024 were enrolled and assigned to Group A(n=32)or Group B(n=32)according to random number table method.Group A received intraoperative ICNB analgesia under direct visualization,while Group B received postoperative acupuncture analgesia.Postoperative visual analogue scale(VAS)scores,Subjective Pain Satisfaction Scores(PSS),time to first ambulation,postoperative inflammatory markers,and the incidence of related adverse events between the two groups were compared.Results At 6 and 12 h after surgery,the VAS scores for Group A were significantly lower than those for Group B(P<0.05).At 36 and 72 h after surgery,Group A demonstrated significantly higher VAS scores than Group B at the 36 to 72 h after surgery(P<0.05).There were no significant differences in the rates of rescue analgesia,length of hospitalization after surgery,and the occurrence of postoperative adverse events between the groups(P>0.05).The time to first ambulation was significantly shorter in Group A[(22.38±5.67)h]compared with Group B[(30.16±6.23)h](P<0.01).At 1 d after surgery,Group A reported higher satisfaction scores than Group B;however,at 3 and 7 d after surgery,satisfaction scores in Group A were lower than those in Group B(P<0.05).At 3 d after surgery,the levels of C reactive protein and white blood cell counts in Group B were significantly lower than those in Group A(P<0.05).Conclusion Both analgesic techniques provided effective pain relief following thoracoscopic surgery.In the early postoperative phase,ICNB under direct visualization yielded superior pain control compared with postoperative acupuncture analgesia.However,over time,the analgesic effect of acupuncture gradually surpassed that of ICNB.Both methods exhibited a low i

关 键 词：肋间神经阻滞 术后针刺镇痛 胸腔镜检查 肺结节 疼痛 手术后 C反应蛋白 白细胞计数 

分 类 号：R614[医药卫生—麻醉学]