胸腔镜与常规开胸手术对肺癌患者术后疼痛的影响.docVIP

题目：两种不同手术方式对肺癌患者术后急性疼痛的影响 作者：邱郁薇 吴镜湘 徐美英 第一作者：邱郁薇 上海交通大学附属胸科医院麻醉科，200030 邮箱：qywcat@ 通讯作者：徐美英 上海交通大学附属胸科医院麻醉科，200030 邮箱：myxu55@ 基金项目：上海市级医院适宜技术联合开发推广应用项目，SHDg/kg+氟比洛芬酯200mg+雷莫司琼0.6mg，生理盐水加至100ml。基础输注速率2ml/h，锁定时间为15min。 观察并记录患者术后24h和48h平静呼吸及用力咳嗽时的视觉模拟疼痛评分（VAS）并将评分进行疼痛程度分级：无痛（VAS0分），轻度疼痛（VAS1～3分），中度疼痛（VAS4～6），重度疼痛（VAS7～10）。结果：共有455例患者最后纳入了本研究。两组术后24h、48h平静呼吸时VAS评分无显著性差异，48h时组1用力咳嗽时VAS评分显著低于组2（P＜0.010.01）；根据秩和检验的结果，术后48h用力咳嗽时VAS分级两者比较差异有统计学意义（P=0.01），平均秩次比较，组1疼痛程度明显优于组2。结论：在相同的PCA配方下，VATS手术较常规开胸手术可明显降低术后患者急性期疼痛评分，降低严重疼痛的发生率；但VATS术后采用单纯静脉镇痛，中重度疼痛仍在部分患者中存在，因此重新评估并制定更为优越的镇痛方案非常重要。 关键词：电视胸腔镜手术，急性疼痛，急性疼痛管理。 Effects of video-assisted thoracoscopic surgery on the postoperative acute pain scores compared with open thoractomy for lung cancer. QIU Yuwei, WU Jingxiang，XU Meiying. Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shangjhai 200030, China [Abstract] Objective: To evaluate the effects of video-assisted thoracoscopic surgery on the postoperative acute pain scores compared with open thoractomy for lung cancer. Methods: Between 2011 January and 2011August, patients with stage Ⅰ～Ⅱnon-small cell lung cancer, ASAⅠ～Ⅱ,age≤70years, BMI≤30kg/m2 were assigned to two groups by type of surgery: Group 1, n=210 cases, patients were enrolled for video-assisted thoracic surgery; Group 2, n=252 cases, patients were under standard open thoracotomy. All patients received total intravenous anesthesia and intravenous patient-controlled analgesia (PCA).Twenty-four hours and forty-eight hours following the surgery, follow-up were done by one resident anesthesiologist including Visual analogue scale (VAS) at rest and at coughing. Pain scale was categorized in the following 4 categories: no pain (VAS 0), mild pain (VAS 1-3), moderate pain (VAS 4-6) and severe pain (VAS7-10).Results: There were 455 cases at last included in this study. Twenty-four hours and forty-eight hours following the surgery, there were no significant differences