肋间神经冷冻术与自控镇痛对开胸术后早期镇痛效果的比较

  目的  比较开胸术后早期3种新镇痛方法的疗效, 探求最佳镇痛方案。  方法  81例开胸术后患者, 随机分为3组, 分别采用患者自控镇痛静脉给药(patient controlled intravenous analgesia, PCIA)、患者自控硬膜外给药(patient controlled epidural analgesia, PCEA)及肋间神经冷冻术(intercostal nerve cryoanalgesia, INC)镇痛, 根据视觉模拟评分法(visual analogue scales, VAS)进行手术日及术后3日疼痛评分, 同时用量表对3种镇痛方法的不良反应进行评价。  结果  PCEA组与PCIA组比较, 所用镇痛药剂量差异无统计学意义(P>0.05), 但用药次数明显减少(P < 0.01);VAS评分示PCEA组镇痛效果明显优于PCIA和INC组(P < 0.01)。术后第2、3天PCEA组较INC组自行排痰能力显著提高(P < 0.01), PCIA组亦较INC组明显提高(P < 0.05)。PCIA组的不良反应显著高于PCEA和INC组(P < 0.01), INC组不良反应显著低于PCIA和PCEA组(P < 0.01)。综合评估指标显示PCEA组显著优于PCIA和INC组(P < 0.01)。  结论  开胸术后早期PCEA的镇痛效果最好, 不良反应较低, 患者排痰能力最强, 综合评价最高, 是3种镇痛方法中的最佳选择。

Comparison of Intercostal Nerve Cryoanalgesia and Patient-controlled Analgesia for Early Post-thoracotomy Pain Control

Objective To compare the effectiveness of three new analgesia methods for early post-thoracotomy pain control.Methods Totally 81 patients randomly accepted one of three new methods for post-thoracotomy analgesia：patient controlled intravenous analgesia（PCIA）,patient controlled epidural analgesia（PCEA）,and intercostal nerve cryoanalgesia（INC）.The effects were evaluated by visual analogue scales（VAS）from the day of thoracotomy to 3 days after operation.Results The dosage was not significantly different between PCEA and PCIA groups（P〉0.05）,but PCEA group had significantly less administration frequency（P〈0.05）.The VAS score was significantly superior in PCEA group than in the other two groups（P〈0.01）.The expectoration ability was significantly better in PCEA group than in INC groups（P〈0.01）,and was significantly better in PCIA group than in INC group（P〈0.05）in the second and the third post-thoracotomy days.The incidence of side effects was significantly higher in PCIA group than in PCEA and INC groups（P〈0.01）,and was significantly lower in INC group than in the other two groups（P〈0.01）.The integrated evaluations showed that PCEA group was significantly better than the other two groups（P〈0.01）.Conclusions PCEA has better analgesic effect than PCIA and INC for post-thoracotomy pain control,lower incidence of side effects,and better expectoration ability.Thus,PCEA is the most suitable method for controlling the early post-thoracotomy pain.