改良肋间神经冷冻和硬膜外自控镇痛在肺癌根治手术后镇痛的比较(1)
【摘 要】 目的: 比较改良肋间神经冷冻和硬膜外自控镇痛在肺癌根治手术后镇痛的效果和副作用。方法:60例择期后外侧切口开胸的肺癌根治术病人,随机分为两组,A组为改良肋间神经冷冻组(n=30),使用北京K001AND公司JT-I型冷冻治疗仅在关胸前对切口所在肋间及上、下各一个肋间和留置胸腔引流管所在肋间的肋间神经进行冷冻;B组为连续硬膜外自控镇痛组(n=30),采用日本wells公司的电子泵,用吗啡加氟哌利多行连续硬膜外自控镇痛(patient control epidural analgesia, PCEA)。两组病人均采用视觉模拟评分法(usual analogue scale,VAS)评定术后疼痛程度,观察两组病人手术后2h、4h、12h、24h、48h时的VAS的评分,恶心、呕吐、呼吸抑制,搔痒、肠麻痹等发生率。结果:A组手术后止痛效果好于B 组,手术后镇痛副反应少于B组,肺癌根治术后镇痛,改良肋间神经冷冻优于PCEA。
【关键词】 肋间神经冷冻 硬膜外 术后镇痛 开胸术 肺癌
, 百拇医药
Comparison between intercostal nerve freezing and epidural analgesia after radical surgery of lung cancer
Chen Jishang
【Abstract】 Objective:To compare the improvement of intercostal nerve freezing and epidural analgesia after radical surgery for lung cancer analgesic effects and side effects.Methods:60 cases of elective posterolateral thoracotomy incision radical operation of lung cancer patients were randomly divided into two groups, A group for the improvement of intercostal nerve freezing group (n=30), the use of Beijing K001AND's JT-I type cryotherapy only in the the intercostal incision is located right off his chest and upper and lower, and retention of an intercostal chest tube drainage of the intercostal nerves intercostal where frozen; B group, continuous epidural analgesia group (n=30), using Japanese wells the company's electronic pump, With morphine plus droperidol-line continuous epidural analgesia (patient control epidural analgesia, PCEA). Two groups of patients are using visual analog scale (usual analogue scale, VAS) assessment of postoperative pain were observed after surgery the patient 2h, 4h, 12h, 24h, 48h, when the VAS scores, nausea, vomiting, respiratory depression , itching, such as incidence of intestinal paralysis.Results:A group of post-operative pain was better than group B, post-operative pain side effects is less than B group, lung cancer and radical postoperative analgesia, improvement intercostal nerve freezing is better than PCEA.
, 百拇医药
【Key words】 Intercostal nerve freezing thoracic Epidural Analgesia after surgery Lung cancer
开胸手术后病人常因切口疼痛而影响呼吸功能、术后恢复及生活质量,良好的术后镇痛可改善患者术后肺功能和减少相关的术后并发症的发生。但良好的镇痛效果也伴随着潜在的副作用。目前开胸术后镇痛的方法较多,但各有利弊,我们比较了改良肋间神经冷冻和目前较为流行的连续硬膜外自控镇痛在肺癌根治手术后的镇痛效果,探讨较好的肺癌根治手术后的镇痛方法。
1 资料与方法
1.1 一般资料。60例择期拟行胸第5肋间,后外侧切口开胸的肺癌根治术病人,随机分为两组。A组30例为术后改良肋间神经冷冻镇痛组;B组30例为术后连续硬膜外自控镇癌组。两组病人一般资料见表Ⅰ。
, http://www.100md.com 表Ⅰ 两组病人一般资料(x±s )
1.2 方法。所有患者均选择双腔管气管插管静脉复合麻醉,B组30例患者在静脉诱导前行T5~6间隙硬膜外穿刺置管,但硬膜外腔不注局麻药;A组30例病人关胸前使用北京K001AND公司JT-I型冷冻手术治疗仪对切口所在肋间及上,下各两个肋间和放置胸腔引流管所在肋间的肋间神经冷冻,冷冻探头温度为-5～-70℃,冷冻气源采用液态CO2,采用单次冷冻法,冷冻时间持续90S,冷冻结束后常规关胸。B组30例病人手术结束时于硬膜外给予首剂:吗啡2mg加氟哌利多1mg的混合液并稀释成10ml,给予首剂后接日本伟氏公司wells三电子泵,采用吗啡6mg加氟哌利多3mg的混合液稀释成60ml,以1ml/h速度连续硬膜外镇痛,追加量为2ml,锁定时间为30min。所有病人完全清醒,拔除气管导管后2h、4h、12h、24h、48h时记录VAS评方分,镇静程度评分,恶心、呕吐、头晕、呼吸抑制的发生情况,见表Ⅱ。
表Ⅱ 两组病人术后各时间点VAS评分(x±s)
1.3 疼痛评估。疼痛程度的评估在病人完全清醒,能正确回答问题以后,未给予任何镇静、镇痛剂的情况下开始评定的,疼痛方案采用视觉模拟评分法(visuel analogue scale,VAS):0~2分为无痛,2~4分为轻疼痛,4~8为中度痛,8~10分为剧烈疼痛。0~4分为镇痛有效,4~8分为止痛无效,其中2、4、8分分别为无痛,轻度疼痛,中度疼痛。
1.4 统计源处。所有数据采用均数土标准差(x ±s)和率(%)表示,应用spss10.0统计分析软件,计量资料采用t检验,计数资料采用x2检验 ,并以P<0.05为差异有显著意义。, http://www.100md.com(陈计赏)
【关键词】 肋间神经冷冻 硬膜外 术后镇痛 开胸术 肺癌
, 百拇医药
Comparison between intercostal nerve freezing and epidural analgesia after radical surgery of lung cancer
Chen Jishang
【Abstract】 Objective:To compare the improvement of intercostal nerve freezing and epidural analgesia after radical surgery for lung cancer analgesic effects and side effects.Methods:60 cases of elective posterolateral thoracotomy incision radical operation of lung cancer patients were randomly divided into two groups, A group for the improvement of intercostal nerve freezing group (n=30), the use of Beijing K001AND's JT-I type cryotherapy only in the the intercostal incision is located right off his chest and upper and lower, and retention of an intercostal chest tube drainage of the intercostal nerves intercostal where frozen; B group, continuous epidural analgesia group (n=30), using Japanese wells the company's electronic pump, With morphine plus droperidol-line continuous epidural analgesia (patient control epidural analgesia, PCEA). Two groups of patients are using visual analog scale (usual analogue scale, VAS) assessment of postoperative pain were observed after surgery the patient 2h, 4h, 12h, 24h, 48h, when the VAS scores, nausea, vomiting, respiratory depression , itching, such as incidence of intestinal paralysis.Results:A group of post-operative pain was better than group B, post-operative pain side effects is less than B group, lung cancer and radical postoperative analgesia, improvement intercostal nerve freezing is better than PCEA.
, 百拇医药
【Key words】 Intercostal nerve freezing thoracic Epidural Analgesia after surgery Lung cancer
开胸手术后病人常因切口疼痛而影响呼吸功能、术后恢复及生活质量,良好的术后镇痛可改善患者术后肺功能和减少相关的术后并发症的发生。但良好的镇痛效果也伴随着潜在的副作用。目前开胸术后镇痛的方法较多,但各有利弊,我们比较了改良肋间神经冷冻和目前较为流行的连续硬膜外自控镇痛在肺癌根治手术后的镇痛效果,探讨较好的肺癌根治手术后的镇痛方法。
1 资料与方法
1.1 一般资料。60例择期拟行胸第5肋间,后外侧切口开胸的肺癌根治术病人,随机分为两组。A组30例为术后改良肋间神经冷冻镇痛组;B组30例为术后连续硬膜外自控镇癌组。两组病人一般资料见表Ⅰ。
, http://www.100md.com 表Ⅰ 两组病人一般资料(x±s )
1.2 方法。所有患者均选择双腔管气管插管静脉复合麻醉,B组30例患者在静脉诱导前行T5~6间隙硬膜外穿刺置管,但硬膜外腔不注局麻药;A组30例病人关胸前使用北京K001AND公司JT-I型冷冻手术治疗仪对切口所在肋间及上,下各两个肋间和放置胸腔引流管所在肋间的肋间神经冷冻,冷冻探头温度为-5～-70℃,冷冻气源采用液态CO2,采用单次冷冻法,冷冻时间持续90S,冷冻结束后常规关胸。B组30例病人手术结束时于硬膜外给予首剂:吗啡2mg加氟哌利多1mg的混合液并稀释成10ml,给予首剂后接日本伟氏公司wells三电子泵,采用吗啡6mg加氟哌利多3mg的混合液稀释成60ml,以1ml/h速度连续硬膜外镇痛,追加量为2ml,锁定时间为30min。所有病人完全清醒,拔除气管导管后2h、4h、12h、24h、48h时记录VAS评方分,镇静程度评分,恶心、呕吐、头晕、呼吸抑制的发生情况,见表Ⅱ。
表Ⅱ 两组病人术后各时间点VAS评分(x±s)
1.3 疼痛评估。疼痛程度的评估在病人完全清醒,能正确回答问题以后,未给予任何镇静、镇痛剂的情况下开始评定的,疼痛方案采用视觉模拟评分法(visuel analogue scale,VAS):0~2分为无痛,2~4分为轻疼痛,4~8为中度痛,8~10分为剧烈疼痛。0~4分为镇痛有效,4~8分为止痛无效,其中2、4、8分分别为无痛,轻度疼痛,中度疼痛。
1.4 统计源处。所有数据采用均数土标准差(x ±s)和率(%)表示,应用spss10.0统计分析软件,计量资料采用t检验,计数资料采用x2检验 ,并以P<0.05为差异有显著意义。, http://www.100md.com(陈计赏)