中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2015年
5期
429-432
,共4页
蒋毅%叶怀华%赵宏%赵恒贻%赵守华
蔣毅%葉懷華%趙宏%趙恆貽%趙守華
장의%협부화%조굉%조항이%조수화
开胸术%肋间神经保护技术%食管癌
開胸術%肋間神經保護技術%食管癌
개흉술%륵간신경보호기술%식관암
Thoracotomy%Protective technique for intercostal nerve%Esophageal cancer
目的 探讨改良肋间神经保护技术在食管癌手术中的应用效果.方法 选择2012年1月至2014年7月施行开胸手术的食管癌、贲门癌患者70例,随机分成观察组和对照组,每组35例;观察组采用改良肋间神经保护技术进行手术操作;对照组采用传统的操作方法进行手术.两组均采用肌肉注射吗啡药物镇痛.结果 观察组术后24h、48 h、72 h、7d、30 d、60d各时点VAS评分与对照组比较,差异均有统计学意义(t值分别为3.041、2.854、1.827、2.156、1.965、2.706,P均＜0.05);观察组的镇痛不良反应发生率、术后30 d及60d无痛患者发生率、吗啡用药剂量、胸管留置时间及平均住院时间分别为0、42.86％、68.57％、(10.6±5.2)mg、(4.0±1.6)d、(17.6±4.5)d,与对照组的17.14％、20.0％、34.29％、(22.8±7.6) mg、(4.8±1.8)d、(20.4±5.8)d相比,差异均有统计学意义(x2值分别为4.56、4.24、8.24,t值分别为7.838、1.965、2.257,P均＜0.05).结论 在食管癌手术中采取改良肋间神经保护技术,既能减轻开胸术后急性疼痛,又能减少慢性疼痛的发生,而且镇痛效果良好,操作简单,不良反应少.
目的 探討改良肋間神經保護技術在食管癌手術中的應用效果.方法 選擇2012年1月至2014年7月施行開胸手術的食管癌、賁門癌患者70例,隨機分成觀察組和對照組,每組35例;觀察組採用改良肋間神經保護技術進行手術操作;對照組採用傳統的操作方法進行手術.兩組均採用肌肉註射嗎啡藥物鎮痛.結果 觀察組術後24h、48 h、72 h、7d、30 d、60d各時點VAS評分與對照組比較,差異均有統計學意義(t值分彆為3.041、2.854、1.827、2.156、1.965、2.706,P均＜0.05);觀察組的鎮痛不良反應髮生率、術後30 d及60d無痛患者髮生率、嗎啡用藥劑量、胸管留置時間及平均住院時間分彆為0、42.86％、68.57％、(10.6±5.2)mg、(4.0±1.6)d、(17.6±4.5)d,與對照組的17.14％、20.0％、34.29％、(22.8±7.6) mg、(4.8±1.8)d、(20.4±5.8)d相比,差異均有統計學意義(x2值分彆為4.56、4.24、8.24,t值分彆為7.838、1.965、2.257,P均＜0.05).結論 在食管癌手術中採取改良肋間神經保護技術,既能減輕開胸術後急性疼痛,又能減少慢性疼痛的髮生,而且鎮痛效果良好,操作簡單,不良反應少.
목적 탐토개량륵간신경보호기술재식관암수술중적응용효과.방법 선택2012년1월지2014년7월시행개흉수술적식관암、분문암환자70례,수궤분성관찰조화대조조,매조35례;관찰조채용개량륵간신경보호기술진행수술조작;대조조채용전통적조작방법진행수술.량조균채용기육주사마배약물진통.결과 관찰조술후24h、48 h、72 h、7d、30 d、60d각시점VAS평분여대조조비교,차이균유통계학의의(t치분별위3.041、2.854、1.827、2.156、1.965、2.706,P균＜0.05);관찰조적진통불량반응발생솔、술후30 d급60d무통환자발생솔、마배용약제량、흉관류치시간급평균주원시간분별위0、42.86％、68.57％、(10.6±5.2)mg、(4.0±1.6)d、(17.6±4.5)d,여대조조적17.14％、20.0％、34.29％、(22.8±7.6) mg、(4.8±1.8)d、(20.4±5.8)d상비,차이균유통계학의의(x2치분별위4.56、4.24、8.24,t치분별위7.838、1.965、2.257,P균＜0.05).결론 재식관암수술중채취개량륵간신경보호기술,기능감경개흉술후급성동통,우능감소만성동통적발생,이차진통효과량호,조작간단,불량반응소.
Objective To investigate the clinical effect of protective technique for intercostal nerve in the application of esophageal cancer surgery.Methods Seventy cases of esophageal and cardia cancer patients with thoracic operation were randomly divided into observation group and control group,and each group was 35 cases.Patients in the observation group were treated with improved protective technique of intercostal nerve during operation,and patients in the control group using the traditional methods of operation for treatment.All patients were treated with intramuscular injection of morphine analgesia drugs after operation.Results The pain score of every time point analgesia patients in the observation group (VAS score) was significant difference from that in the control group (t =3.041,2.854,1.827,2.156,1.965,2.706,P＜ 0.05).The incidence of adverse reactions of analgesia,the incidence of painless patients of postoperative 30 d and 60 d,morphine dosage,chest tube indwelling time and the average hospitalization time in observation group were 0,42.86％,68.57％,(10.6±5.2) mg (4.0±1.6) d,(17.6±4.5) d,and the control group were 17.14％,20.0％,34.29％,(22.8±7.6) mg,(4.8±1.8) d,(20.4±5.8) d (x2=4.56,4.24,8.24,t=7.838,1.965,2.257,P＜0.05).Conclusion The improvement protective technique for intercostal nerve in esophageal cancer surgery,not only can reduce thoracotomy acute postoperative pain,but also reduce the happening of the CPP.Meanwhile,the analgesic effect is good.It is proved with a simple operation,less adverse reaction,conducive to disease recovery after esophageal cancer surgery,indicating that it has clinical popularization value.
