目的 探讨肋间神经冷冻术应用于电视胸腔镜手术(VATS)后的镇痛效果及安全性.方法 该研究为前瞻性随机对照研究.选择2014年5月至2015年4月胸外科同一手术组并符合择期手术条件的患者80例,根据随机数字表法,将符合纳入标准的患者分为冷冻组和静脉组,每组40例.记录术后4h、1d、2d、3d的运动和静息视觉模拟评分(VAS)以及吗啡补充使用量、不良反应发生率.检测术前及术后4h、1d、2d血浆皮质醇、血糖、C-反应蛋白(CRP)及白细胞介素乇(IL-6)的血浆浓度.结果 71例患者完成全部试验过程并进行统计分析,其中冷冻组35例,静脉组36例,2组患者在年龄、性别、体质指数(BMI)等一般临床资料方面的差异均无统计学意义(均P>0.05).冷冻组运动VAS评分在术后4h、1d、2d、3d分别为5(5,7)、4(3,6)、3(3,4)、3(0,3)分,静脉组分别为5(5,6)、5(3,5)、3(3,4)、2(0,3)分,差异均无统计学意义(均P>0.05);冷冻组静息VAS评分在术后4h、1d、2d、3d分别为3(2,4)、0(0,3)、0(0,0)、0(0,0)分,静脉组分别为3(0.5,4)、2(0,3)、0(0,1.5)、0(0,0)分,差异均无统计学意义(均P>0.05).2组在术后4h、1d、2d吗啡使用量相同,冷冻组吗啡累积使用量高于静脉组,但2组间的差异无统计学意义(P>0.05);冷冻组、静脉组在静息时的镇痛有效率(VAS≤5分)分别为91.4%和97.2%;静脉组恶心、呕吐发生率为36.1%,明显高于冷冻组的17.1% (x2 =4.148,P<0.05);血浆中皮质醇、CRP、IL-6的浓度在术后有比较明显的改变,但在各时间点的差异均无统计学意义.结论 VATS下肋间神经冷冻术的镇痛效果与静脉镇痛相同;相比静脉镇痛,冷冻组患者不良反应的发生率低,不增加应激反应.
目的 探討肋間神經冷凍術應用于電視胸腔鏡手術(VATS)後的鎮痛效果及安全性.方法 該研究為前瞻性隨機對照研究.選擇2014年5月至2015年4月胸外科同一手術組併符閤擇期手術條件的患者80例,根據隨機數字錶法,將符閤納入標準的患者分為冷凍組和靜脈組,每組40例.記錄術後4h、1d、2d、3d的運動和靜息視覺模擬評分(VAS)以及嗎啡補充使用量、不良反應髮生率.檢測術前及術後4h、1d、2d血漿皮質醇、血糖、C-反應蛋白(CRP)及白細胞介素乇(IL-6)的血漿濃度.結果 71例患者完成全部試驗過程併進行統計分析,其中冷凍組35例,靜脈組36例,2組患者在年齡、性彆、體質指數(BMI)等一般臨床資料方麵的差異均無統計學意義(均P>0.05).冷凍組運動VAS評分在術後4h、1d、2d、3d分彆為5(5,7)、4(3,6)、3(3,4)、3(0,3)分,靜脈組分彆為5(5,6)、5(3,5)、3(3,4)、2(0,3)分,差異均無統計學意義(均P>0.05);冷凍組靜息VAS評分在術後4h、1d、2d、3d分彆為3(2,4)、0(0,3)、0(0,0)、0(0,0)分,靜脈組分彆為3(0.5,4)、2(0,3)、0(0,1.5)、0(0,0)分,差異均無統計學意義(均P>0.05).2組在術後4h、1d、2d嗎啡使用量相同,冷凍組嗎啡纍積使用量高于靜脈組,但2組間的差異無統計學意義(P>0.05);冷凍組、靜脈組在靜息時的鎮痛有效率(VAS≤5分)分彆為91.4%和97.2%;靜脈組噁心、嘔吐髮生率為36.1%,明顯高于冷凍組的17.1% (x2 =4.148,P<0.05);血漿中皮質醇、CRP、IL-6的濃度在術後有比較明顯的改變,但在各時間點的差異均無統計學意義.結論 VATS下肋間神經冷凍術的鎮痛效果與靜脈鎮痛相同;相比靜脈鎮痛,冷凍組患者不良反應的髮生率低,不增加應激反應.
목적 탐토륵간신경냉동술응용우전시흉강경수술(VATS)후적진통효과급안전성.방법 해연구위전첨성수궤대조연구.선택2014년5월지2015년4월흉외과동일수술조병부합택기수술조건적환자80례,근거수궤수자표법,장부합납입표준적환자분위냉동조화정맥조,매조40례.기록술후4h、1d、2d、3d적운동화정식시각모의평분(VAS)이급마배보충사용량、불량반응발생솔.검측술전급술후4h、1d、2d혈장피질순、혈당、C-반응단백(CRP)급백세포개소탁(IL-6)적혈장농도.결과 71례환자완성전부시험과정병진행통계분석,기중냉동조35례,정맥조36례,2조환자재년령、성별、체질지수(BMI)등일반림상자료방면적차이균무통계학의의(균P>0.05).냉동조운동VAS평분재술후4h、1d、2d、3d분별위5(5,7)、4(3,6)、3(3,4)、3(0,3)분,정맥조분별위5(5,6)、5(3,5)、3(3,4)、2(0,3)분,차이균무통계학의의(균P>0.05);냉동조정식VAS평분재술후4h、1d、2d、3d분별위3(2,4)、0(0,3)、0(0,0)、0(0,0)분,정맥조분별위3(0.5,4)、2(0,3)、0(0,1.5)、0(0,0)분,차이균무통계학의의(균P>0.05).2조재술후4h、1d、2d마배사용량상동,냉동조마배루적사용량고우정맥조,단2조간적차이무통계학의의(P>0.05);냉동조、정맥조재정식시적진통유효솔(VAS≤5분)분별위91.4%화97.2%;정맥조악심、구토발생솔위36.1%,명현고우냉동조적17.1% (x2 =4.148,P<0.05);혈장중피질순、CRP、IL-6적농도재술후유비교명현적개변,단재각시간점적차이균무통계학의의.결론 VATS하륵간신경냉동술적진통효과여정맥진통상동;상비정맥진통,냉동조환자불량반응적발생솔저,불증가응격반응.
Objective To investigate the analgesic efficacy and safety of intercostal nerve cryoanalgesia after video-assisted thoracoscopic surgery (VATS).Methods This was a prospective randomized controlled study.From May 2014 to April 2015,80 patients who would undergoing selective surgery performed by the same surgeon team were chosen,and were randomly divided into cryoanalgesia group and intravenous analgesia group by a random number table.Visual analogue scale (VAS) at resting and movement were measured on postoperative 4 h,1 d,2 d,3 d,and the amount of supplemental morphine use and adverse reactions were recorded;plasma concentration of cortisol,blood glucose,C-reactive protein (CRP) and intedeukin-6 (IL-6) were detected on preoperative and postoperative 4 h,1 d,2 d.Results Seventy-onepatients with complete test process were included in the statistical analysis,including cryoanalgesia group (35 cases) and intravenous group (36 cases).No statistical differences were found in terms of age,gender,body mass index (BMI) between the two groups.VAS scores of cryoanalgesia group at movement on postoperative4h,1 d,2 d,3 d were 5(5,7),4(3,6),3(3,4),3(0,3),and in intravenous group were 5 (5,6),5 (3,5),3 (3,4),2 (0,3),respectively,but there was no statistically different between two groups (P > 0.05).Resting VAS scores of cryoanalgesia group on postoperative 4 h,1 d,2 d,3 d were 3(2,4),0(0,3),0(0,0),0(0,0),and in intravenous group were 3(0.5,4),2(0,3),0 (0,1.5),0 (0,0) respectively,but there was no statistically different between two groups (P > 0.05).Resting analgesic effectiveness (VAS≤5) of cryoanalgesia group were 91.4%,and in intravenous group were 97.2%,respectively.Median of morphine dosage was equal between two groups on postoperative 4 h,1 d,2 d,cumulative amount of morphine of cryoanalgesia group was higher than intravenous group,but the difference between the two groups was not statistically significant.Incidence of nausea and vomiting for intravenous group was 36.1%,significantly higher than cryoanalgesia group (17.1%,x2 =4.148,P < 0.05).The change of plasma concentration of cortisol,C-response protein(CRP),interleuken-6(IL-6) was noticeable,but there was no statistical significance in each time point.Conclusion The analgesic effect of both Intercostal nerve cryoanalgesia and intravenous analgesia after VATS is almost the same.Compare with intravenous analgesia,incidence of the adverse reactions of cryoanalgesia is lower,and there is no increasing in the stress response.