摘要
目的比较全静脉麻醉(total intravenous anaesthesia,TIVA)与静吸复合麻醉对慢性开胸术后疼痛综合征(chronic post-thoracotomy pain syndrome,CPTS)发病率的影响。方法选取2016年10月至2018年5月在解放军总医院第六医学中心进行胸廓切开术的患者,年龄18~75岁,ASA分级Ⅰ、Ⅱ级,肺癌和食管癌外科手术治疗阶段。通过计算机生成的随机数将患者分为两组:全静脉麻醉组(Ⅰ组,173例)接受丙泊酚+瑞芬太尼TIVA,静吸复合麻醉组(Ⅱ组,170例)接受0.8 MAC七氟醚吸入麻醉。术中维持BIS在40~50。使用疼痛数字评分(Numerical Rating Scale,NRS)对两组患者术后1、3、5 d的急性疼痛进行评估,统计3个月和术后6个月的CPTS发病率,比较两组患者术后3个月与术后6个月的疼痛特征和止痛药使用情况。结果两组患者在人员组成和围手术期参数上差异均无统计学意义(P>0.05)。术后1、3、5 d镇静和咳嗽状态的NRS评分差异无统计学意义(P>0.05)。Ⅰ组术后3个月和术后6个月CPTS及触痛发病率、术后6个月新发疼痛发病率低于Ⅱ组(P<0.05)。两组患者术后3个月和术后6个月NRS评分、主要疼痛特征(针刺痛和酸痛)、止痛药使用情况差异无统计学意义(P>0.05)。结论使用丙泊酚和瑞芬太尼TIVA在术后3个月和术后6个月时可降低CPTS的发病率。
Objective Thoracotomy is one of the most painful surgical incisions.Little is known,however,about effect of anesthesia method on chronic post-thoracotomy pain syndrome(CPTS).The therefore compared the incidence of CPTS after total intravenous anaesthesia(TIVA)with the inhalation anaesthesia combined with intravenous anesthesia.Methods Selected patients who underwent thoracotomy at the China PLA General Hospital Sixth Medical Center from October 2016 to May 2018,aged 18 to 75 years,American Society of Anesthesiologists(ASA)gradeⅠandⅡand in the surgical treatment stage of lung cancer or esophageal cancer.Patients were prospectively randomized into two groups:group I received TIVA(2.0-2.5 mg·kg-1·h-1 propofol+0.2 mg·kg-1·h-1 remifentanil)and groupⅡreceived inhalation anaesthesia with 0.8 minimum alveolar concentration(MAC)sevoflurane.Intraoperative bispectral index(BIS)levels is in 40-50.Acute pain was assessed acute pain on postoperative days 1,3 and 5 while the prevalence of CPTS at 3 and 6 months using a Numerical Rating Scale(NRS).Pain symptoms and postoperative medication usage at 3 and 6 months in the two groups of patients.Results There was no significant difference between the two groups in terms of personnel composition and perioperative parameters(P>0.05).There was no significant difference in NRS scores of sedation and cough at 1,3 and 5 days after operation(P>0.05).The incidence rate of CPTS and tenderness at 3 and 6 months after operation,and the incidence rate of new onset pain at 6 months after operation in group I were lower than that in groupⅡ(P<0.05).There was no significant difference in NRS score,main pain characteristics(needle prick and ache)and analgesic dose between the two groups at 3 months and 6 months after operation(P>0.05).Conclusions TIVA with propofol and remifentanil may reduce the incidence of CPTS at 3 and 6 months.
作者
李鹏
吕浩
李亮
田冶
陈宇
李军
Li Peng;Lyu Hao;Li Liang;Tian Ye;Chen Yu;Li Jun(China PLA General Hospital Sixth Medical Center,Beijing 100048,China)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第8期785-789,共5页
International Journal of Anesthesiology and Resuscitation
关键词
慢性开胸术后疼痛综合征
丙泊酚
瑞芬太尼
全静脉麻醉
Chronic post-thoracotomy pain syndrome
Propofol
Remifentanil
Total intravenous anaesthesia
