肋间神经冷冻术在胸部手术后镇痛的临床研究(1)
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[摘要] 目的 探讨肋间神经冷冻在胸部术后的镇痛效果。方法 将200例单纯后外侧切口开胸手术患者随机分为观察组(肋间神经冷冻治疗组)100例和对照组100例，比较两组患者术后镇痛效果、肺部并发症发生率、术后使用麻醉镇痛药及肺功能情况。结果 观察组患者疼痛程度显著弱于对照组(P<0.01)；术后咳嗽、咳痰评分优良率显著高于对照组(P<0.01)；肺部并发症发生率显著低于对照组(P<0.01)；术后3d内镇痛药需求量也显著低于对照组(P<0.01)。观察组术后肺功能恢复时间较快，肺功能在术后第3天及第7天与对照组相比有显著差异(P<0.01)。结论 肋间神经冷冻治疗对开胸手术后镇痛效果明显，能减少肺部并发症发生，且不会对肋间神经造成永久性损害，是一种简便、有效、安全的镇痛方法， 值得临床大力推广使用。
[关键词] 肋间神经冷冻治疗； 开胸术；镇痛；临床研究
[中图分类号] R655 [文献标识码] B [文章编号] 1673-9701(2011)23-48-03
Analgesic Effect of Cryoanalgesia by Freezing Intercostals Nerves in Post-thoracotomy
PANG Wenguang HUANG Fengliu YE Min
Department of Thoracic Surgery, Guangdong Province Jiangmen Central Hospital，Jiangmen 529030，China
[Abstract] Objective To investigate the effects of cryoanalgesia by freezing intercostals nerves on pain and respiratory complications in patients undergoing thoracotomy. Methods Two hundreds cases of simple incision posterolateral thoracotomy were randomly divided into two groups，observation group(intercostal nerve freezing treatment group) of 100 cases and 100 cases of the control group. Compared the postoperative analgesia，pulmonary complications rate，postoperative use of narcotic analgesics and pulmonary function. Results Pain of observation group patients were significantly weaker than the control group(P<0.01)；Postthoracotomy coughing， sputum score were significantly higher than the control group(P<0.01)；Pulmonary complication rate was significantly lower than control group(P<0.01)；After three days demand the analgesics was significantly lower than the control group(P<0.01). Postoperative pulmonary function of observation group recovered faster than the control group; Pulmonary function after three days and seven days compared with the control group were significantly different(P<0.01). Conclusion The treatment of cryoanalgesia by freezing intercostals nerves is significant on post-thoracotomy analgesia，can reduce the occurrence of pulmonary complications，and do not cause permanent damage to the intercostal nerve. It is a simple，effective and safe analgesic method and worthy of great efforts to promote use ......
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