【摘要】 目的 研究全身麻醉腹部手术患者术前焦虑对术后疼痛、镇痛药用量及对术后镇痛满意度的影响。 方法 选取2009年8月-2010年4月68例ASAⅠ～Ⅱ级，拟行气管插管全身麻醉的腹部手术患者，术前采用状态-特质焦虑量表和抑郁评分量表进行焦虑程度的测评，术后观察VAS疼痛评分、总的镇痛药用量以及患者对镇痛的满意度，分析术前焦虑与术后VAS评分、镇痛药用量及镇痛满意度的相关性。 结果 68例受试者术前STAI为50±13，BDI为16±13，术后VAS评分为4.0±2.1，术后24 h镇痛药芬太尼的用量为（0.80±0.21） mg；术后镇痛药用量、患者镇痛满意度评分与术前STAI明显相关（r=0.68和r=-0.88，Plt;0.01）。术后VAS评分与术前STAI及BDI也有一定的相关（r=0.35和r=0.3）。 结论 术前焦虑程度可以影响腹部手术患者对镇痛治疗的满意度， 显著增加镇痛药用量。【Abstract】 Objective To investigate the effect of preoperative anxiety on postoperative pain, amount of analgesics and satisfaction of postoperative pain relief for patients undergoing abdominal surgery with general anesthesia. Methods A total of 68 patients undergoing abdominal surgery with general anesthesia from August 2009 to April 2010 were selected (ASA I-II). Preoperational anxiety levels were evaluated using State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) and postoperative VAS pain score, the total amount of analgesics used and satisfaction of pain relief were observed. The relationship between preoperative anxiety and post-operative VAS score, and total amount of analgesics used and satisfaction of pain relief were analyzed. Results The mean STAI and BDI of 68 samples were 50±13 and 16±13, respectively; the mean postoperative VAS was 4.0±2.1, and the mean amount of analgesics fentanyl used in 24 hours after the operation was (0.80±0.21) mg; the amount of post-operative analgesics used and the satisfaction of pain relief of the patients were found to be highly related to pre-operative STAI (r=0.68, -0.88; Plt;0.01). Post-operative VAS score was also related to preoperational STAI and BDI (r=0.35, 0.3). Conclusion Preoperative anxiety is closely related to the postoperative analgesics and satisfaction of pain relief for patients who had abdominal operation. Severe preoperative anxiety can significantly increase the amount of postoperative analgesics used and dissatisfaction of pain relief.
ObjectiveTo explore the feasibility to use pain scale and arterial oxygen partial pressure(PaO2)as screening internal fixation indications for patients with multiple rib fractures. MethodsClinical data of 48 patients with multiple rib fractures who were admitted to Shanghai Pudong Hospital from September 2010 to February 2013 were retrospectively analyzed. Visual analogue scale (VAS) was used for pain assessment. Twenty-four patients whose VAS was greater than or equal to 6 and PaO2 was less than 60 mm Hg 3 days after injury were chosen as the experimental group, including 16 males and 8 females with their age of 49.29±15.73 years. Another 24 patients whose VAS was less than or equal to 5 and PaO2 was greater than 60 mm Hg 3 days after injury were chosen as the control group, including 19 males and 5 females with their age of 48.63±13.49 years. Patients in both groups received rib internal fixation with steel plates. Three days and 1 week after surgery respectively, VAS and PaO2 were compared between the 2 groups. ResultsIn the experimental group, VAS 3 days after surgery was significantly lower than preoperative VAS (4.09±0.93 vs. 8.21±1.18, P < 0.05), and VAS 1 week after surgery was significantly lower than preoperative VAS (3.20±0.98 vs. 8.21±1.18, P < 0.05). In the control group, there was no statistical difference between VAS 3 days after surgery and preoperative VAS (P > 0.05), and there was no statistical difference between VAS 1 week after surgery and preoperative VAS (P > 0.05). Three days after surgery, PaO2 of the experimental group was significantly higher than preoperative PaO2 (61.00±3.47 mm Hg vs. 53.00±3.97 mm Hg, P < 0.05). There was no statistical difference between PaO2 3 days after surgery and preoperative PaO2 in the control group (66.71±5.15 mm Hg vs. 66.00±5.00 mm Hg, P > 0.05). Three days after surgery, pneumonia occurred in 4 patients in the experimental group and 2 patients in the control group (χ2=0.762, P > 0.05). Three days after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (4.13±1.45 vs. 0.00±0.42, P < 0.05). One week after surgery, pain scale reduction of the experimental group was significantly higher than that of the control group (5.04±1.23 vs. 0.08±0.28, P < 0.05). Three days after surgery, PaO2 increase of the experimental group was significantly higher than that of the control group (7.42±3.59 mm Hg vs. 0.21±0.98 mmHg, P < 0.05). ConclusionIt's reasonable and feasible to use pain scale greater than or equal to 6 and PaO2 less than 60 mm Hg as internal fixation indications for patients with multiple rib fractures.
ObjectiveWe aimed to further investigate the feasibility of using small bore chest tubes or even without chest tube insertion after da Vinci robot-assisted thoracic surgery. MethodsWe retrospectively analyzed initial 70 patients between September 12, 2014 and March 30, 2015 as a control group at the department of thoracic surgery, the First Affiliated Hospital of Zhejiang University, and proposed four schemes. There are 31 males and 39 females with mean age of 57.1±9.8 (ranged from 30-80 years). We applied those four schemes for the last 30 patients as an experimental group. There are 12 males and 18 females with mean age of 58.8±8.1 (ranged 42-73 years). ResultsThe days in hospital after surgery ranged 2-25 days and there was no severe complication. After the surgery, the pain scores of the trial group are lower than that of the control group. And the schemes 1 and schemes 2 of trial group reduced significantly than the control group (P<0.05). There is no significant difference of the rate of the complication caused by poor drainage between the trial group and the control group (P>0.05). But the pain score after surgery is lower than that of the control group (P<0.05). ConclusionOptimizing thoracic drainage strategy after da Vinci robot-assisted thoracic surgery is safe, possible and helpful to relieve postoperative pain.
ObjectiveTo investigate the effects of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) and intercostal uniportal VATS (IUVATS) in lobectomy for non-small cell lung cancer (NSCLC).MethodsA total of 428 patients with NSCLC who underwent lobectomy via SUVATS or IUVATS from July 1st to 31st, 2019 in Shanghai Pulmonary Hospital were enrolled. Patient characteristics, perioperative outcomes and postoperative pain scores at different time points were collected. The patients were divided into a SUVATS group (80 patients, 42 males and 38 females with an average age of 58.8±9.6 years) and an IUVATS group (348 patients, 161 males and 187 females, with an average age of 61.2±10.0 years). The clinical effectiveness of the two groups was compared.ResultsThere was no significant difference in sex (P=0.314), age (P=0.052), preoperative pulmonary function (P=0.701), combined chronic comorbidities (chronic cardiovascular disease, P=0.775; chronic obstructive pulmonary disease, P=0.678) and postoperative pathology (P=0.132) between the two groups. Compared with the IUVATS group, patients in the SUVATS group had longer operation time (155.6±34.4 min vs. 141.3±27.0 min, P<0.001), less intraoperative blood loss (165.2±160.6 mL vs. 223.7±272.4 mL, P<0.001), shorter time of chest tube use (4.3±2.0 d vs. 4.9±1.9 d, P=0.011) and less postoperative pain score at different time points (postoperative 8 h, P<0.001; postoperative day 1, P=0.019; postoperative day 2, P=0.015; the day before discharge, P<0.001).ConclusionSUVATS is a safe and effective technique for lobectomy in NSCLC patients with less postoperative pain and can promote postoperative recovery.