人工气胸联合肋间神经阻滞用于减轻近胸膜肺肿瘤微波消融术疼痛的疗效分析

摘要

Objective To discuss the clinical effect of artificial pneumothorax combined with intercostal nerve block in alleviating chest pain occurring during and after percutaneous microwave ablation (MWA) for subpleural lung malignancy.Methods A total of 30 patients with subpleural lung malignancy were randomly and equally divided into group A (n=10),group B (n=10) and group C (n=10).The patients in group A received both artificial pneumothorax and intercostal nerve block before MWA.The patients in group B only received artificial pneumothorax before MWA,and the patients in group C only received intercostal nerve block before MWA.The degree of pain was evaluated by visual analogue scale (VAS) score during MWA,immediately after MWA and at 6 h,12 h and 24 h after WMA.The side effects after MWA were recorded.Results During MWA,no statistically significant differences in VAS scores existed between each other among the three groups (P=0.885).The VAS scores determined at 6 h,12 h and 24 h after MWA in group C were significantly increased (P=0.014,P=0.006 and P=0.006 respectively).No patient in group A and group B developed symptoms of chest tightness after artificial pneumothorax was performed.After treatment,a small amount of asymptomatic residual pneumothorax was still observed in 6 patients of group A and group B,which disappeared spontaneously in about one week.Another patient still showed massive pneumothorax even after thoracic gas suction,and the patient recovered after thoracic closed drainage for three days.No other serious complications related to artificial pneumothorax occurred.Conclusion Artificial pneumothorax combined with intercostal nerve block can effectively relieve the chest pain occurring during and after MWA in patients with subpleural lung malignancy,and clinically this technique is quite safe.(J Intervent Radiol,2017,26:269-273)%目的 探讨人工气胸联合肋间神经阻滞用于减轻近胸膜肺肿瘤微波消融(MWA)术中及术后疼痛的疗效.方法 将30例近胸膜肺肿瘤患者分为3组,每组10例,A组MWA前先实施人工气胸联合肋间神经阻滞,B组MWA前单纯实施人工气胸,C组MWA前单纯行肋间神经阻滞.用疼痛视觉模拟评分(VAS)评定各组患者术中及术后0、6、12和24 h的疼痛程度,记录患者术后不良反应出现情况.结果 3组患者术中VAS评分无明显差异(P=0.885);C组患者在术后6、12和24 h的VAS评分均明显增高(P=0.014,0.006,0.006).A组和B组患者实施人工气胸后均未出现胸闷症状;A组和B组中共6例患者术后仍有少量无症状残余气胸,约1周后残余气胸自行吸收消失,1例患者术后抽气后仍存在较大范围气胸,经行胸腔闭式引流3d后痊愈.无其它严重人工气胸相关并发症.结论 人工气胸联合肋间神经阻滞能够有效减轻近胸膜肺肿瘤患者MWA术中及术后疼痛,安全性高.