摘要
目的探讨胸腔镜下精准留置肋间神经阻滞管控制老年患者单孔胸腔镜肺术后疼痛的效果,为治疗疼痛提供方法。方法选择2019年7月1日-2019年9月27日在青岛市市立医院胸外科接受单孔胸腔镜肺手术后的老年患者60例,按随机数表法随机分成3组:E组、S组和C组(对照组);E组采取胸腔镜下留置肋间神经阻滞管;S组采取术中单次给予肋间神经阻滞。所有患者均给予经静脉自控镇痛(PCIA)及肺术后静脉推注帕瑞昔布钠。在拔除气管插管后1 h、6 h、12 h、24 h、36 h、48 h,评估并比较各组疼痛评分(VAS);观察并比较各组吗啡应用情况、胸腔闭式引流管拔管时间、PCIA按压次数、消化系统及神经系统症状。结果与C组比较,E组VAS评分明显降低(P<0.01);S组在1 h和6 h时间点VAS评分显著降低(P<0.05),而在12 h^48 h时间点VAS评分差异均无统计学意义(P>0.05)。与C组比较,E组吗啡用量明显减少(P<0.01),PCIA按压次数明显减少(P<0.01),胸腔闭式引流管拔管时间明显提前(P<0.05),消化系统及神经系统症状发生率明显减少(P<0.05)。与C组比较,S组吗啡用量、PCIA按压次数、胸腔闭式引流管拔管时间以及消化及神经系统症状发生率差异均无统计学意义(P>0.05)。结论精准留置肋间神经阻滞管在控制老年患者单孔胸腔镜肺术后疼痛方面有显著优势,可减少全身用药量,术后并发症明显减少,胸腔闭式引流管拔管时间明显缩短,具有一定的临床应用价值。
Objective To explore the effect of precise indwelling intercostal nerve block tube under thoracoscopy to control the pain after single hole thoracoscopic lung surgery in elderly patients,and provide a method for the treatment of pain.Method Sixty elderly patients who underwent single hole thoracoscopic lung surgery in Department of Thoracic Surgery of Qingdao Municipal Hospital(Group)from July 1 to September 27,2019 were enrolled and divided into three groups according to random number table:group E,group S and groupC(control group).In group E,intercostal nerve block tube was placed under thoracoscope,while in group S,intercostal nerve block was given once during operation.All patients were given PCIA and intravenous injection of parecoxib sodium after lung operation.The pain scores(VAS)were evaluated and compared among the three groups at 1 h,6 h,12 h,24 h,36 h and 48 h after tracheal intubation removal.The use of morphine,the extubation time of closed thoracic drainage tube,the number of PCIA compression,the symptoms of digestive systemand nervous system were observed and compared one another.Results Compared with group C,the VAS score of group E was significantly lower(P<0.01);the VAS score of group S was significantly lower at 1 h and 6 h(P<0.05),but there was no significant difference in VAS score at 12 to 48 h.Compared with group C,the use of morphine in group E was significantly reduced(P<0.01),number of PCIAcompression were significantly reduced(P<0.01),the extubation time of closed thoracic drainage tube was significantly earlier(P<0.05),and the incidence of digestive and neurological symptoms was significantly reduced(P<0.05).There were no significant differences in the use of morphine,the number of PCIAcompression,extubation time of closed thoracic drainage tube and incidence of digestive and nervous system symptoms between group S and group C(P>0.05).Conclusions Precise indwelling intercostal nerve block tube has significant advantages in controlling postoperative pain of elderly patients after single hole thoracoscopic lung surgery,which can reduce the systemic drug consumption,significantly reduce the postoperative complications,and shorten extubation time of closed thoracic drainage tube,which has certain clinical application value.
作者
刘蕾
王东飞
梁效民
谭林
李飞
李论
Liu Lei;Wang Dongfei;Liang Xiaoming;Tan Lin;Li Fei;Li Lun(Department of Thoracic Surgery,Affiliated Hospital of Qingdao University,Qingdao,Shandong,266003,P.R.China;Department of Thoracic Surgery,Qingdao Municipal Hospital(Group),Qingdao,Shandong,266071,P.R.China)
出处
《老年医学与保健》
CAS
2020年第6期984-987,共4页
Geriatrics & Health Care
关键词
老年
肺术后
肋间神经阻滞管
疼痛
视觉模拟评分法
并发症
elderly
post-pneumonectomy
intercostal nerve block tube
pain
visual analogue scale
complications
