改進關胸技術對開胸術后疼痛及血氣分析的影響_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 黃標通 , 熊衛民 , 龍建平 , 楊彬 , 劉劍 , 肖玉彬 , 王銳

;

Corresponding?author：

黃標通, Email: hbt163@sina.com

Keywords：

肋間肌平行褥式縫合; 關胸術; 減輕疼痛

DOI：

10.7507/1007-4848.20140241

Video：

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目的探討開胸手術患者的關胸技術改進對減輕術后早期疼痛的效果。方法選取2010年11月至2012年7月湖南師范大學第二附屬醫院心胸外科連續住院開胸手術患者78例，男53例、女25例，年齡18～73（51.4±5.7）歲。根據電腦隨機數字法將患者分為常規關胸組和改進關胸組，每組39例。胸內操作完成后，常規關胸組關胸時直接用7號絲線繞切口上一肋間及下一肋骨肋間縫合打結關閉胸腔；改進關胸組用7號絲線于切口兩邊肋間肌的中間（即原切除肋骨的上下肋間肌）行平行褥式縫合，收線打結關閉胸腔。結果兩組圍術期均無死亡。根據疼痛視覺模擬評分（VAS），改進關胸組各時點的疼痛評分均明顯低于常規關胸組（P<0.05）。常規關胸組動脈血氧分壓（PaO₂）、動脈血二氧化碳分壓（PaCO₂）的變化均較改進關胸組顯著（P<0.05）。結論通過改進關胸技術，采用肋間肌平行褥式縫合法，可避免肋間神經損傷，有效減輕術后早期疼痛，減少對術后呼吸功能的影響。

Citation： 黃標通, 熊衛民, 龍建平, 楊彬, 劉劍, 肖玉彬, 王銳. 改進關胸技術對開胸術后疼痛及血氣分析的影響. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 839-841. doi: 10.7507/1007-4848.20140241 Copy

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3.	黃標通, 龍建平, 熊衛民, 等.改良側切口在普胸手術中的應用.實用醫學雜志, 2005, 21(2):196.
4.	Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain:risk factors and protective factors. Expert Rev Neurother, 2009, 9(5):723-744.
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8.	倪武, 林育超, 陸兆貴, 等.剖胸術改良關胸方法的遠期疼痛效果觀察.實用心腦肺血管病雜志, 2008, 16(9):19-20.
9.	趙恒貽, 徐洪玲, 刁金秀, 等.避開下方肋間神經縫合肋間切口防治側開胸手術后切口疼痛.中外醫療, 2010, 29(4):45.
10.	Cerfolio RJ, Price TN, Bryant AS, et al. Intracostal sutures decrease the pain of thoracotomy. Ann Thorac Surg, 2003, 76(2):407-412.
11.	伍火志, 李杰, 賴運興, 等.肋骨內縫合減輕開胸術后疼痛.中國胸心血管外科臨床雜志, 2006, 13(2), 137.
12.	Bayram AS, Ozcan M, Kaya FN, et al. Rib approximation without intercostal nerve compression reduces post-thoracotomy pain:a prospective randomized study. Eur J Cardiothorac Surg, 2011, 39(4):570-574.
13.	Visagan R, McCormack DJ, Shipolini AR, et al. Are intracostal sutures better than pericostal sutures for closing a thoracotomy? Interact Cardiovasc Thorac Surg, 2012, 14(6):807-815.
14.	鐘守平, 潘龍毅, 陸莎, 等.跨肋骨縫合關胸對開胸術后的疼痛的影響.實用醫技雜志, 2008, 15(14), 1858-1859.
15.	Sakakura N, Usami N, Taniguchi T, et al. Assessment of long-term postoperative pain in open thoracotomy patients:pain reduction by the edge closure technique. Ann Thorac Surg, 2010, 89(4):1064-1070.
16.	Cerfolio RJ, Bryant AS, Maniscalco LM. A nondivided intercostal muscle flap further reduces pain of thoracotomy:a prospective randomized trial. Ann Thorac Surg, 2008, 85(6):1901-1907.
17.	黃云, 趙夏.慢性剖胸術后胸痛的隨訪研究.海南醫學, 2012, 23(2):48-50.

1. Allama AM. Intercostal muscle flap for decreasing pain after thoracotomy:a prospective randomized trial. Ann Thorac Surg, 2010, 89(1):195-199.
2. Maguire MF, Latter JA, Mahajan R, et al. A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery. Eur J Cardiothorac Surg, 2006, 29(6):873-879.
3. 黃標通, 龍建平, 熊衛民, 等.改良側切口在普胸手術中的應用.實用醫學雜志, 2005, 21(2):196.
4. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain:risk factors and protective factors. Expert Rev Neurother, 2009, 9(5):723-744.
5. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain:risk factors and prevention. Lancet, 2006, 367(9522):1618-1625.
6. Buvanendran A, Kroin JS, Kerns JM, et al. Characterization of a new animal model for evaluation of persistent postthoracotomy pain. Anesth Analg, 2004, 99(5):1453-1460.
7. Steegers MA, Snik DM, Verhagen AF, et al. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain, 2008, 9(10):955-961.
8. 倪武, 林育超, 陸兆貴, 等.剖胸術改良關胸方法的遠期疼痛效果觀察.實用心腦肺血管病雜志, 2008, 16(9):19-20.
9. 趙恒貽, 徐洪玲, 刁金秀, 等.避開下方肋間神經縫合肋間切口防治側開胸手術后切口疼痛.中外醫療, 2010, 29(4):45.
10. Cerfolio RJ, Price TN, Bryant AS, et al. Intracostal sutures decrease the pain of thoracotomy. Ann Thorac Surg, 2003, 76(2):407-412.
11. 伍火志, 李杰, 賴運興, 等.肋骨內縫合減輕開胸術后疼痛.中國胸心血管外科臨床雜志, 2006, 13(2), 137.
12. Bayram AS, Ozcan M, Kaya FN, et al. Rib approximation without intercostal nerve compression reduces post-thoracotomy pain:a prospective randomized study. Eur J Cardiothorac Surg, 2011, 39(4):570-574.
13. Visagan R, McCormack DJ, Shipolini AR, et al. Are intracostal sutures better than pericostal sutures for closing a thoracotomy? Interact Cardiovasc Thorac Surg, 2012, 14(6):807-815.
14. 鐘守平, 潘龍毅, 陸莎, 等.跨肋骨縫合關胸對開胸術后的疼痛的影響.實用醫技雜志, 2008, 15(14), 1858-1859.
15. Sakakura N, Usami N, Taniguchi T, et al. Assessment of long-term postoperative pain in open thoracotomy patients:pain reduction by the edge closure technique. Ann Thorac Surg, 2010, 89(4):1064-1070.
16. Cerfolio RJ, Bryant AS, Maniscalco LM. A nondivided intercostal muscle flap further reduces pain of thoracotomy:a prospective randomized trial. Ann Thorac Surg, 2008, 85(6):1901-1907.
17. 黃云, 趙夏.慢性剖胸術后胸痛的隨訪研究.海南醫學, 2012, 23(2):48-50.

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改進關胸技術對開胸術后疼痛及血氣分析的影響

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