镇痛治疗方法对开胸术后患者心肺并发症的影响

THE EFFECT OF PAIN AND ANALGESIA ON POSTTHORACOTOMY CARDIOPULMO- NARY COMPLICATION

摘要:

目的:探讨疼痛与镇痛治疗对开胸术后患者心肺并发症的影响。方法:总结516例开胸行肺叶切除或食管癌切除患者术后六日的疼痛情况。采用术中肋间神经冷冻、自控硬膜外镇痛、静脉泵镇痛和一般镇痛四种方法,根据视觉模拟评分(VAS)法对术后胸痛进行评级。将疼痛4级以下的患者定为充分镇痛组,5级以上的患者定为不充分镇痛组,结合二组术后心肺并发症的发生情况进行分析。结果:在充分镇痛组中,术后肺部并发症、心脏并发症和总的心肺并发症发生率分别为13.73%、4.41%和15.20%;不充分镇痛组中分别为25.32%,12.5%和30.77%,均有显著的统计学意义,术中肋间神经冷冻、硬膜外镇痛、静脉泵镇痛、一般镇痛的充分镇痛率分别为75.79%、52.17%、43.08%、11.93%。结论:术后镇痛治疗以充分降低疼痛评分(VAS≤4级)为目的,加强术后充分镇痛治疗是预防开胸术后心肺并发症的重要措施之一。

Abstract:

Objective: To investigate the effect of pain and analgesia on postthoracotomy cardiopulmonary complication. Methods:The degree of pain from the first day to the sixth day of postoperation in 516 patients with pulmonary lobectomy or esophagectomy was analysed.In these cases, four methods of cryoanalgesia,epidural analgesia,intravenous analgesia,intramuscular analgesia were used. Visual analogue scales(VAS) was analysed to determine the degree of pain. This cases were divided into full analgesia and insufficiency analgesia group by VAS (less than or equal to 4 and larger than 5),and postthoracotomy cardiopulmonary complication was investigated in two groups. Results:The postoperative total rates of the cardiopulmonary complication in full analgesia group and isufficiency analgesia group were 15.20% and 30.77%. The rates of pulmonary complication and cardiac complication in two groups were 13.73%, 25.32% and 4.41%, 12.5% respectively. All had significant difference between two groups(P<0.05). The rates of the full analgesia in the methods of cryoanalgesia, epidural analgesia, intravenous analgesia, intramuscular analgesia were 75.79%, 52.17%, 43.08%, 11.93% respectively. Conclusion: The purpose of postthoracotomy analgesia is to control the degree of pain less than or equal to 4 with VAS. Full postthoracotomy analgesia is one of the significant measure to decrease cardiopulmonary complications.