多模式联合治疗在开胸术后镇痛中的应用效果

摘要
图/表
参考文献(15)
相关文章 (13)

全文: PDF (0 KB) HTML (39 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨多模式联合治疗在开胸术后镇痛中的可行性。方法选取2016年3月～2018年3月于我院就诊的60 例开胸肺部手术患者作为研究对象，依据镇痛方案的不同将其分成A 组（单纯自控式止痛）、B 组（在A 组的基础上联合肋间神经阻滞）和C 组（在B 组的基础上联合术中肋间神经保护），每组各20 例。记录三组患者的手术时间、胸管拔除时间、住院时间及治疗前、治疗后24、48 h 的平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）；根据视觉模拟（VAS）评分法评估三组患者麻醉清醒后、拔除胸管后1 d、术后1 个月及术后2 个月的疼痛度，并比较三组患者的不良反应发生情况。结果 C 组患者的胸管拔管时间短于A 组，差异有统计学意义（P＜0.05）；三组患者的手术时间及住院时间比较，差异无统计学意义（P＞0.05）。三组患者治疗前的MAP、HR 及SpO2 比较，差异无统计学意义（P＞0.05）；B 组、C 组患者治疗后24 h 的MAP 及HR 均低于A 组，差异有统计学意义（P＜0.05）；B 组、C 组患者治疗后48 h 的HR 均低于A 组，差异有统计学意义（P＜0.05）；C 组患者治疗后48 h 的HR 低于B组，差异有统计学意义（P＜0.05）。C 组患者麻醉清醒后、拔除胸管后1 d 及术后1 个月的VAS 评分均低于A 组和B 组，差异有统计学意义（P＜0.05）；B 组患者麻醉清醒后、拔除胸管后1 d 的VAS 评分均低于A 组，差异有统计学意义（P＜0.05）；三组患者术后2 个月的VAS 评分比较，差异无统计学意义（P＞0.05）。C 组患者的不良反应总发生率低于A 组和B 组，差异有统计学意义（P＜0.05）。结论多模式联合治疗在开胸术后镇痛中的效果显著，不良反应少。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘俊
	孔羽
	曾庆武
	李志勇
	熊薇

关键词 ：开胸手术, 术后疼痛, 肋间神经阻滞麻醉

Abstract： Objective To explore the feasibility of multimode combined therapy in the analgesia after thoracotomy.Methods A total of 60 patients with thoracotomy who were admitted to our hospital from March 2016 to March 2018 were selected as research objects and they were divided into group A (simple self-controlled analgesia), group B (combined with intercostal nerve block on the basis of group A) and group C (combined with intraoperative intercostal nerve protection on the basis of group B) according to different analgesia regimens, with 20 cases in each group.The operation time, chest tube removal time, hospitalization time, and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO2) before treatment, and 24, 48 h after treatment among the three groups of patients were recorded.Visual analogue scale (VAS) score was used to evaluate the pain after anesthetic awareness, 1 d after chest tube removal and at 1 month and 2 months after operation of the three groups.The incidence of adverse reactions was compared in three groups of patients.Results The chest tube removal time of group C was shorter than that of group A, and the difference was statistically significant (P＜0.05).There were no significant differences in the operation time and hospitalization time among the three groups (P＞0.05).There were no significant differences in the MAP, HR and SpO2 among the three groups (P＞0.05).The MAP and HR of group B and group C were lower than those of group A 24 h after treatment, and the differences were statistically significant (P＜0.05).The HR of group B and group C was lower than that of group A 48 h after treatment, and the differences were statistically significant (P＜0.05).The HR of group C was lower than that of group B 48 h after treatment, and the difference was statistically significant (P＜0.05).The VAS scores of patients in group C after anesthesia, 1 d after removal of chest tube and 1 month after operation were lower than those in group A and group B, and the differences were statistically significant (P＜0.05).The VAS scores of group B after anesthesia awareness and 1 d after removal of chest tube were lower than those of group A, and the differences were statistically significant (P＜0.05).There were no significant differences in VAS scores among the three groups 2 months after operation (P＞0.05).The total incidence rate of adverse reactions in group C was lower than that in group A and group B, and the differences were statistically significant (P＜0.05).Conclusion Multimode combined therapy has significant analgesic effect after thoracotomy with fewer adverse reactions.

Key words： Thoracotomy Postoperative pain Intercostal nerve block anesthesia

基金资助:江西省新余市科技计划项目（201630908011）

作者简介: 刘俊（1985-），男，江西新余人，硕士，主治医师，研究方向：肺癌诊治

引用本文:

刘俊；孔羽；曾庆武；李志勇；熊薇. 多模式联合治疗在开胸术后镇痛中的应用效果[J]. 中国当代医药, 2019, 26(12): 98-101.
LIU Jun； KONG Yu ；ZENG Qing-wu； LI Zhi-yong ；XIONG Wei. Application effect of multimode combined therapy in the analgesia after thoracotomy. 中国当代医药, 2019, 26(12): 98-101.

链接本文:

http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2019/V26/I12/98

[1]	朱阿芳，申乐，许力，等.开胸手术后慢性疼痛的危险因素[J].临床麻醉学杂志，2018，34（4）：397-400.
[2]	周向阳，孙建洋，邱玉雪，等.术后不同镇痛方式对开胸肿瘤手术患者T 淋巴细胞亚群的影响[J].宁夏医科大学学报，2016，38（9）：1040-1043.
[3]	闫辉，李正明，张莲花，等.羟考酮联合肋间神经阻滞在老年患者胸科术后镇痛中的临床观察[J].临床与病理杂志，2017，37（4）：719-723.
[4]	陈炎春，樊超.麻醉风险评估及分级管理平台对麻醉安全的影响研究[J].医院管理论坛，2018，35（5），20-22.
[5]	秦雪，刘娟，鲁开智，等.多联数字评分量表在开胸术后患者自控静脉镇痛方案中的应用[J].第三军医大学学报，2018，40（16）：1518-1522.
[6]	王立婷，吴安石.术后镇痛与快速康复外科[J].北京医学，2015，37（8）：774-776.
[7]	高敏，刘文雄，宁俊萍.氢吗啡酮自控镇痛在老年食管癌患者开胸术后中的应用[J].医学临床研究，2016，33（10）：1938-1940.
[8]	李桂芹，刘纪泽，刁玉刚，等.地佐辛复合舒芬太尼用于全麻开胸患者术后静脉镇痛的临床观察[J].实用药物与临床，2016，19（3）：322-326.
[9]	汲振荣，唐冰，裴凌.超声引导下椎旁神经阻滞在开胸手术及术后镇痛中的应用[J].中国医师进修杂志，2016，39（2）：168-171.
[10]	李明月，刘伟，赖冰洁，等.老年患者开胸手术术后镇痛的研究进展[J].中国老年学杂志，2016，36（6）：1522-1524.
[11]	蒋毅，王君，陶宏，等.改良肋间神经保护联合静脉自控镇痛多模式防治开胸术后疼痛的应用[J].中国临床实用医学，2016，7（5）：34-37.
[12]	杨赵栋，张百军.罗哌卡因在术前与术毕肋间神经阻滞中对开胸手术镇痛效果的比较[J].浙江实用医学，2016，21（1）：35-36.
[13]	庆淑梅，曹亚楠，孙振涛，等.椎旁神经阻滞用于开胸术老年患者超前镇痛的效果[J].中华麻醉学杂志，2016，36（2）：168-170.
[14]	散小虎，张在斌，朱辉，等.B 超引导椎旁神经阻滞用于开胸术后镇痛效果的观察[J].现代中西医结合杂志，2016，25（2）：205-207.
[15]	林惠华，陈香，杨艳琴.三种不同镇痛方法对开胸术后镇痛效果的比较观察[J].齐齐哈尔医学院学报，2014，35（2）：291-293.