改进关胸技术对开胸术后疼痛及血气分析的影响_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 黄标通 , 熊卫民 , 龙建平 , 杨彬 , 刘剑 , 肖玉彬 , 王锐

;

Corresponding author：

黄标通, Email: hbt163@sina.com

Keywords：

肋间肌平行褥式缝合; 关胸术; 减轻疼痛

DOI：

10.7507/1007-4848.20140241

Video：

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目的探讨开胸手术患者的关胸技术改进对减轻术后早期疼痛的效果。方法选取2010年11月至2012年7月湖南师范大学第二附属医院心胸外科连续住院开胸手术患者78例，男53例、女25例，年龄18～73（51.4±5.7）岁。根据电脑随机数字法将患者分为常规关胸组和改进关胸组，每组39例。胸内操作完成后，常规关胸组关胸时直接用7号丝线绕切口上一肋间及下一肋骨肋间缝合打结关闭胸腔；改进关胸组用7号丝线于切口两边肋间肌的中间（即原切除肋骨的上下肋间肌）行平行褥式缝合，收线打结关闭胸腔。结果两组围术期均无死亡。根据疼痛视觉模拟评分（VAS），改进关胸组各时点的疼痛评分均明显低于常规关胸组（P<0.05）。常规关胸组动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）的变化均较改进关胸组显著（P<0.05）。结论通过改进关胸技术，采用肋间肌平行褥式缝合法，可避免肋间神经损伤，有效减轻术后早期疼痛，减少对术后呼吸功能的影响。

Citation： 黄标通, 熊卫民, 龙建平, 杨彬, 刘剑, 肖玉彬, 王锐. 改进关胸技术对开胸术后疼痛及血气分析的影响. 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.	黄标通, 龙建平, 熊卫民, 等.改良侧切口在普胸手术中的应用.实用医学杂志, 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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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, 陆兆贵, 等.剖胸术改良关胸方法的远期疼痛效果观察.实用心脑肺血管病杂志, 2008, 16(9):19-20.
9.	赵恒贻, 徐洪玲, 刁金秀, 等.避开下方肋间神经缝合肋间切口防治侧开胸手术后切口疼痛.中外医疗, 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, 赖运兴, 等.肋骨内缝合减轻开胸术后疼痛.中国胸心血管外科临床杂志, 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.	钟守平, 潘龙毅, 陆莎, 等.跨肋骨缝合关胸对开胸术后的疼痛的影响.实用医技杂志, 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.	黄云, 赵夏.慢性剖胸术后胸痛的随访研究.海南医学, 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. 黄标通, 龙建平, 熊卫民, 等.改良侧切口在普胸手术中的应用.实用医学杂志, 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, 陆兆贵, 等.剖胸术改良关胸方法的远期疼痛效果观察.实用心脑肺血管病杂志, 2008, 16(9):19-20.
9. 赵恒贻, 徐洪玲, 刁金秀, 等.避开下方肋间神经缝合肋间切口防治侧开胸手术后切口疼痛.中外医疗, 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, 赖运兴, 等.肋骨内缝合减轻开胸术后疼痛.中国胸心血管外科临床杂志, 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. 钟守平, 潘龙毅, 陆莎, 等.跨肋骨缝合关胸对开胸术后的疼痛的影响.实用医技杂志, 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. 黄云, 赵夏.慢性剖胸术后胸痛的随访研究.海南医学, 2012, 23(2):48-50.

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改进关胸技术对开胸术后疼痛及血气分析的影响

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