Zhou Pan, Zhu Jie, Zhu Jiang, Ma Jun
Thoracic Surgery, Wuhan Hanyang Hospital, Wuhan, Hubei Province, China.
Department of Anesthesiology, Wuhan Hanyang Hospital, Wuhan, Hubei Province, China.
Medicine (Baltimore). 2024 Nov 22;103(47):e40583. doi: 10.1097/MD.0000000000040583.
This retrospective study evaluates the clinical impact of perioperative multimodal analgesia in the minimally invasive treatment of severe blunt chest trauma with hemopneumothorax using a thoracoscopic Ni-Ti shape memory embracing plate. A total of 100 patients with severe blunt chest trauma and moderate to severe hemopneumothorax treated at Hanyang Hospital affiliated with Wuhan University of Science and Technology from January 2019 to January 2022 were enrolled. Patients were divided into 2 groups: a control group (50 patients) receiving patient-controlled intravenous analgesia (PCIA), and a study group (50 patients) administered a multimodal analgesia regimen. Pain severity scores, vital signs, and inflammatory markers were compared between the groups. Post-surgery, both groups exhibited reductions in resting and movement-associated pain scores compared to admission values, with the study group showing significantly greater reductions (P < .05). Specifically, the average heart rate in the study group was 78 ± 8 beats per minute compared to 85 ± 9 beats per minute in the control group at 3 days postsurgery (P < .05). The respiratory rate was also lower in the study group (18 ± 2 breaths per minute) compared to the control group (21 ± 3 breaths per minute; P < .05). Improvements in blood oxygen saturation were observed postoperatively in both groups, with more pronounced changes in the study group (P < .05). Although levels of interleukin-6, tumor necrosis factor-α, and C-reactive protein increased postoperatively in both groups, these increases were significantly lower in the study group (P < .05). Perioperative multimodal analgesia in patients with severe blunt chest trauma and pneumothorax enhances postoperative recovery, reduces pain, minimizes lung complications, and lowers the usage of analgesic drugs and their associated adverse effects.
本回顾性研究评估了围手术期多模式镇痛在使用胸腔镜镍钛形状记忆环抱式接骨板微创治疗严重钝性胸部创伤并血气胸中的临床影响。纳入了2019年1月至2022年1月在武汉科技大学附属汉阳医院接受治疗的100例严重钝性胸部创伤并中重度血气胸患者。患者分为2组:对照组(50例患者)接受患者自控静脉镇痛(PCIA),研究组(50例患者)采用多模式镇痛方案。比较两组的疼痛严重程度评分、生命体征和炎症标志物。术后,与入院时相比,两组静息和活动相关疼痛评分均降低,研究组降低更为显著(P<0.05)。具体而言,术后3天研究组平均心率为每分钟78±8次,对照组为每分钟85±9次(P<0.05)。研究组呼吸频率也低于对照组(每分钟18±2次呼吸)(对照组为每分钟21±3次呼吸;P<0.05)。两组术后血氧饱和度均有改善,研究组变化更明显(P<0.05)。虽然两组术后白细胞介素-6、肿瘤坏死因子-α和C反应蛋白水平均升高,但研究组升高幅度明显更低(P<0.05)。严重钝性胸部创伤和气胸患者围手术期多模式镇痛可促进术后恢复、减轻疼痛、减少肺部并发症,并降低镇痛药的使用及其相关不良反应。