Miyazaki Takuro, Sakai Tetsuya, Yamasaki Naoya, Tsuchiya Tomoshi, Matsumoto Keitaro, Tagawa Tsutomu, Hatachi Go, Tomoshige Koichi, Mine Mariko, Nagayasu Takeshi
Division of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan,
Gen Thorac Cardiovasc Surg. 2014 Jan;62(1):58-63. doi: 10.1007/s11748-013-0328-z. Epub 2013 Oct 6.
Chest tube insertion seems to be one important factor leading to intercostal nerve impairment. The purpose of this prospective study was to objectively evaluate intercostal nerve damage using current perception threshold testing in association with chest tube insertion.
Sixteen patients were enrolled in this study. Intercostal nerve function was assessed with a series of 2000-Hz (Aβ fiber), 250-Hz (Aδ fiber), and 5-Hz (C fiber) stimuli using current perception threshold testing (Neurometer CPT/C(®)). Current perception threshold values at chest tube insertion were measured before surgery, during chest tube insertion and after removal of the chest tube. Intensities of ongoing pain were also assessed using a numeric rating scale (0-10).
Current perception thresholds at each frequency after surgery were significantly higher than before surgery. Numeric rating scale scores for pain were significantly reduced from 3.3 to 1.9 after removal of the chest tube (p = 0.004). The correlation between current perception threshold value at 2000 Hz and intensity of ongoing pain was marginally significant (p = 0.058).
This is the first study to objectively evaluate intercostal nerve damage at chest tube insertion. The results confirmed that chest tube insertion has clearly deleterious effects on intercostal nerve function.
胸腔闭式引流管置入似乎是导致肋间神经损伤的一个重要因素。本前瞻性研究的目的是通过使用电流感觉阈值测试结合胸腔闭式引流管置入来客观评估肋间神经损伤。
本研究纳入了16例患者。使用电流感觉阈值测试（Neurometer CPT/C(®)），通过一系列2000赫兹（Aβ纤维）、250赫兹（Aδ纤维）和5赫兹（C纤维）刺激来评估肋间神经功能。在手术前、胸腔闭式引流管置入期间和胸腔闭式引流管拔除后测量胸腔闭式引流管置入时的电流感觉阈值。还使用数字评分量表（0-10）评估持续疼痛的强度。
术后各频率的电流感觉阈值均显著高于术前。胸腔闭式引流管拔除后，疼痛的数字评分量表评分从3.3显著降低至1.9（p = 0.004）。2000赫兹时的电流感觉阈值与持续疼痛强度之间的相关性边缘显著（p = 0.058）。
这是第一项客观评估胸腔闭式引流管置入时肋间神经损伤的研究。结果证实，胸腔闭式引流管置入对肋间神经功能有明显的有害影响。
