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。

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。

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)。

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。

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

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.

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).

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.