切换至 "中华医学电子期刊资源库"
高级检索
中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2020, Vol. 07 ›› Issue (01) : 30 -35. doi: 10.3877/cma.j.issn.2095-8773.2020.01.005

所属专题： 文献；

论著

胸腔镜肺段切除手术后多模镇痛的临床研究
米芳1, 刘敏1, 张淑云1, 汤汉清1, 邱美蓉1, 吕宝华1, 黄晓媚1, 卓龙彩1,†()   
  1. 1. 361000　厦门，中国人民解放军陆军第73集团军医院胸外科
  • 收稿日期:2019-01-12 出版日期:2020-02-28
  • 通信作者: 卓龙彩

Clinical study on multimodal analgesia after thoracoscopic segmentectomy

Fang Mi1, Min Liu1, Shuyun Zhang1, Hanqing Tang1, Meirong Qiu1, Baohua Lyu1, XiaoMei Huang1, Longcai Zhuo1,†()   

  1. 1. Department of Thoracic Surgery, PLA 73rd Group Army Hospital, Xiamen, 361000, China
  • Received:2019-01-12 Published:2020-02-28
  • Corresponding author: Longcai Zhuo
  • About author:
    Corresponding author: Zhuo Longcai, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

米芳, 刘敏, 张淑云, 汤汉清, 邱美蓉, 吕宝华, 黄晓媚, 卓龙彩. 胸腔镜肺段切除手术后多模镇痛的临床研究[J]. 中华胸部外科电子杂志, 2020, 07(01): 30-35.

Fang Mi, Min Liu, Shuyun Zhang, Hanqing Tang, Meirong Qiu, Baohua Lyu, XiaoMei Huang, Longcai Zhuo. Clinical study on multimodal analgesia after thoracoscopic segmentectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(01): 30-35.

目的

观察和分析胸腔镜下肺段切除术后多模镇痛的效果和安全性。

方法

选取全身麻醉下行单操作孔胸腔镜下单肺段切除术的患者，按手术时间先后交替分入对照组(单纯自控静脉镇痛)和试验组(多模镇痛)。对照组仅于手术后予静脉镇痛泵止痛，疼痛明显时自控追加剂量，如疼痛仍无缓解，则追加吗啡皮下注射。试验组做手术切口和缝合切口时采取肋间神经保护的策略，胸腔内手术操作结束后行胸腔镜下肋间神经阻滞，胸腔内喷洒利多卡因，术后予静脉镇痛泵止痛同对照组。比较两组患者术后各时间点的Prince-Henry疼痛评分(PHPS)、按压镇痛泵和注射吗啡次数、住院时间及毒麻药品相关不良反应和并发症的发生情况。

结果

两组分别纳入41例患者，性别、身高、体重、手术肺段、手术时间等基础情况的差异均无统计学意义(P>0.05)。试验组术后6、12、18、24 h的PHPS评分显著低于对照组(P<0.05)，术后0～24 h、24～48 h按压镇痛泵次数和术后0～24 h注射吗啡次数均显著少于对照组(P<0.05)；两组间术后36、48 h的PHPS评分、术后24～48 h注射吗啡次数、术后住院时间、毒麻药品相关不良反应发生率和术后并发症发生率的差异均无统计学意义(P>0.05)。

结论

胸腔镜下肺段切除术后行多模镇痛的效果优于单纯的静脉镇痛泵镇痛，且实施简单，适合在临床推广。

关键词: 胸腔镜, 多模镇痛, 肋间神经阻滞, 肋间神经保护, 肺段切除
Objective

To observe and analyze the effect and safety of multimodal analgesia after thoracoscopic segmentectomy.

Methods

Patients who underwent single-operator-orifice thoracoscopic segmentectomy under general anesthesia were selected and divided into control group (PCIA analgesia) and test group (multimodal analgesia) according to the operation time order alternately. The control group was only given an intravenous analgesic pump for pain relief after surgery, and the patients could press the analgesic pump for additional dose when the pain was obvious. If the pain did not improve, an additional hypodermic injection of morphine would be given. The experimental group adopted an intercostal neuroprotective strategy during surgical incision and suture incision. After intrathoracic surgery, thoracoscopic intercostal nerve block was performed, lidocaine was sprayed in the chest, and postoperative intravenous analgesia pump was given to relieve pain as in the control group. The pain PHPS scores of the two groups were recorded at 6 time points at 6h, 12h, 18h, 24h, 36h and 48h after surgery. The PHPS scores, the times of pressing the analgesic pump , the times of additional morphine injection within 0-24 hours and 24-48 hours after the operation, the postoperative hospital stay, the incidence of drug-related adverse reactions of anaesthesia, and the complication rate were recorded and compared between the two groups.

Results

41 patients were included in each group, and there were no statistically significant differences in gender, height, weight, location of the removed lung segment, operation time and other basic conditions (P>0.05). The PHPS scores at 6, 12, 18 and 24 h after operation in the experimental group were significantly lower than those in the control group (P<0.05). The times of pressing PCIA and injecting morphine at 0-24h and 24-48h after the operation were also significantly lower than those in the control group (P<0.05). There were no statistically significant differences in PHPS scores at 36h and 48h after surgery, times of morphine injection at 24-48 h after surgery, postoperative hospital stay, incidence of drug-related side effects and complications (P>0.05).

Conclusions

After thoracoscopic segmentectomy, the above multimodal analgesia was better than intravenous analgesia pump analgesia, and it was simple to implement and suitable for clinical promotion.

Key words: Thoracoscopy, Multimodal analgesia, Intercostal nerve block, Intercostal nerve protection, Segmentectomy
图1 胸腔镜下肋间神经阻滞
表1 两组患者基本资料比较
项目 试验组(N＝41) 对照组(N＝41) χ2 /t值 P值
性别(n) ? ? 0.195 0.525
? 男性 19 21 ? ?
? 女性 22 20 ? ?
年龄(岁，±s) 59.24±8.642 58.34±8.463 0.478 0.634
身高(cm，±s) 167.52±8.77 168.60±9.24 -0.539 0.591
体重(kg，±s) 66.20±9.25 69.54±9.44 -1.618 0.110
手术时间(min，±s) 140.05±23.41 139.17±21.62 -0.176 0.860
手术切除肺段(n) ? ? 4.176 0.964
? 右上肺尖段 4 5 ? ?
? 右上肺后段 4 5 ? ?
? 右上肺前段 5 4 ? ?
? 右下肺背段 5 5 ? ?
? 右下肺前基底段 1 3 ? ?
? 右下肺外基底段 1 2 ? ?
? 右下肺后基底段 2 3 ? ?
? 左上肺尖后段 4 4 ? ?
? 左上肺前段 3 4 ? ?
? 左上肺下舌段 5 3 ? ?
? 左下肺背段 4 2 ? ?
? 左下肺前基底段 3 1 ? ?
表2 两组患者术后各时间点PHPS评分比较(±s，分)
组别 术后6 h 术后12 h 术后18 h 术后24 h 术后36 h 术后48 h
试验组(N＝41) 0.61±0.67 0.39±0.49 0.68±0.47 0.78±0.57 0.78±0.42 0.59±0.50
对照组(N＝41) 2.27±0.92 2.27±0.63 1.78±0.42 1.39±0.54 0.83±0.59 0.78±0.42
t值 9.332 14.972 11.146 4.960 0.433 1.918
P值 0.000 0.000 0.000 0.000 0.666 0.059
表3 两组患者术后镇痛泵按压次数、吗啡注射次数和住院时间比较(±s)
组别 术后镇痛泵按压次数 术后吗啡注射次数 术后住院时间(min)
0～24 h 24～48 h 0～24 h 24～48 h
试验组(N＝41) 6.20±2.87 6.02±2.57 0.17±0.38 0.17±0.38 3.68±1.57
对照组(N＝41) 13.20±4.55 7.27±2.42 0.39±0.49 0.22±0.42 3.56±1.75
t值 8.334 2.225 2.225 0.552 －0.332
P值 0.000 0.027 0.027 0.583 0.741
[1]
Kwon S, Zhao L, Reddy R, et al. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection[J]. J Thorac Cardiovasc Surg, 2017, 154(2)：652-659.
[2]
Palade E, Guenter J. Postoperative pain in the acute phase after surgery: VATS lobectomy vs. open lung resection - results of a prospective randomised trial[J]．Zentralbl Chir, 2014, 139(S 01)：S59-S66.
[3]
Doan LV, Augustus J, Androphy R, et al.Mitigating the impact of acute and chronic post-thoracotomy pain[J]. J Cardiothorac Vasc Anesth, 2014, 28(4)：1048-1056.
[4]
朱建权，魏巍，赵洪伟，等. 改良式罗哌卡因肋间神经阻滞在胸腔镜手术中的应用[J]. 中国肿瘤临床，2019, 46(12)：611-614.
[5]
林夏兰，周华成. 胸神经阻滞方法研究进展[J]. 中国疼痛医学杂志，2017, 23 (11)：851-854.
[6]
Ahmed Z, Samad K, Ullah H. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial[J]. Saudi J Anaesth, 2017, 11(1)：54-57.
[7]
Vlassakov K, Vafai A, Ende D，et al. A prospective, randomized comparison of ultrasonographic visualization of proximal intercostal block vs paravertebral block[J]. BMC Anesthesiol, 2020, 20(1)：13.
[8]
Deng K, Xu S J, Qian Y F, et al. Application of continuous serratus plane block with patient-controlled analgesia on postoperation analgesia after thoracoscopic surgery[J]. Zhonghua yi xue za zhi, 2018, 98(8)：570-575.
[9]
Piccioni F, Segat M, Falini S, et al. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols[J]. J Thorac Dis, 2018, 10(S4)：S555-S563.
[10]
Pinheiro V F, da Costa J M, Cascudo M M, et al. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: a randomized trial study[J]. Rev Lat Am Enfermagem, 2016, 23 (6)：1000-1006.
[11]
Zhang X, Shu L, Lin C, et al. Comparison between intraoperative two-space injection thoracic paravertebral block and wound infiltration as a component of multimodal analgesia for postoperative pain management after video-assisted thoracoscopic lobectomy: a randomized controlled trial[J]. J Cardiothorac Vasc Anesth, 2015, 29(6)：1550-1556.
[12]
Chen S, Zhu X, Huang L, et al. Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study[J]. Int J Surg, 2019, 69：132-138.
[13]
Samimi S, Taheri A, Davari Tanha F. Comparison between intraperitoneal and intravenous lidocaine for postoperative analgesia after elective abdominal hysterectomy, a double-blind placebo controlled study[J]. J Family Reprod Health, 2015, 9(4)：193-198.
[14]
Perniola A, Magnuson A, Axelsson K, et al. Intraperitoneal local anesthetics have predominant local analgesic effect: a randomized, double-blind study[J]. Anesthesiology, 2014, 121(2)：352-361.
[15]
Wang C F, Pancaro C, Gerner P, et al. Prolonged suppression of postincisional pain by a slow-release formulation of lidocaine[J]. Anesthesiology, 2011, 114(1)：135- 149.
[1] 陈经欣, 李梅, 陈洁雅. 肺结节胸腔镜术后肺部感染危险因素分析[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 238-243.
[2] 陈静, 张春明, 周斌, 吴明明. 甲苯磺酸瑞马唑仑联合瑞芬太尼全身麻醉对胸腔镜肺叶切除患者术后应激反应及血清PAF、γ干扰素的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 554-556.
[3] 赵璐, 尹文静, 贾萌. 不同肺复张策略在老年胸腔镜术中的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 382-384.
[4] 张文汇, 马森, 徐秋香. 肢体远隔缺血预处理对单孔胸腔镜肺叶切除术后影响分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 239-241.
[5] 李祥魁, 薛玉荣, 丁凯, 孔劲松. ESPB、SAPB、TPVB对胸腔镜微创术血流动力学、应激反应的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 245-247.
[6] 刘龙, 褚红军, 邢春花, 佘勇军. 超声引导下SAPB与ESPB在胸腔镜手术中的应用效果及术后疼痛分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 70-73.
[7] 李彦君, 李明前, 曹安, 杨朝坤. 全胸腔镜肺叶切除术后支气管残端旁单根细管负压引流的应用分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 80-82.
[8] 陈静, 张春明, 周斌, 吴明明. 不同负荷剂量右美托咪定联合酮咯酸氨丁三醇对胸腔镜肺癌根治术后疼痛和认知功能的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 86-88.
[9] 宁晓矿, 郝普明, 闫睿, 刘云泽, 李宬润. 单向式三孔胸腔镜肺叶切除术治疗早期肺癌应用研究[J]. 中华腔镜外科杂志(电子版), 2023, 16(04): 227-232.
[10] 罗伟, 李易泽, 曹然, 张旭刚, 尹庆, 王昆. 单孔胸腔镜下2枪法在右肺上叶切除术中的运用体会[J]. 中华胸部外科电子杂志, 2023, 10(04): 200-206.
[11] 李正龙, 赵永生, 罗钶鑫, 彭忠勤. 胸腔镜切除治疗全内脏反位合并食管癌手术1例并文献复习[J]. 中华胸部外科电子杂志, 2023, 10(04): 234-237.
[12] 陈立如, 刘亮, 彭雷, 徐全, 章晔. 单孔胸腔镜左肺下叶袖式切除术：新辅助免疫化疗后手术[J]. 中华胸部外科电子杂志, 2023, 10(04): 228-233.
[13] 杨杨, 刘永志, 刘军峰, 周雪涛, 张东升. 回顾性分析完全胸腔镜下肋骨骨折内固定术治疗肋骨骨折患者的临床效果[J]. 中华胸部外科电子杂志, 2023, 10(03): 137-142.
[14] 王新桥, 马超英, 张旭光. 纵隔单中心型Castleman病诊治体会及文献复习[J]. 中华胸部外科电子杂志, 2023, 10(03): 183-187.
[15] 贾卓奇, 李硕, 陈健, 张广健, 付军科. 新辅助治疗后胸腹腔镜下Ivor-Lewis食管胃结合部腺癌根治术1例并文献复习[J]. 中华胸部外科电子杂志, 2023, 10(02): 111-116.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号