The Affection Of Protective Technique For Intercostal Nerve On The Pains Of Patients After Performed Thoracotomy

Objective:The pain of patients performed conventional open thoracic surgery is a serious phenomenon of pain after the surgery.The pain degree of patients performed conventional open thoracic surgery is the most persistent and severe in a variety of postoperative pain.To give effective analgesia can improve the life quality of the patients of thoracic surgery and improve the success rate of operation. The visual analogue scale method is applied in this article. By comparing the conventional closure technique and protection of intercostal nerve closure technique on the effects of different periods of the pain of the patients after operation, provide the clinical basis for reducing post thoracotomy pain.Methods:a retrospective study of fourth Hebei Medical University Hospital East from 2014 February to 2014 July in Department of thoracic surgery about conventional open chest operation, in 84 cases, 46 cases of male, 38 cases of female. 42 cases of intercostal nerve protection technology were selected as experimental group, 42 cases used routine closure technique were treated as control group. In the experimental group,22 cases of male, 20 cases of female,the average age is(58.90 ±6.71)years,12 cases of lung disease, 30 cases of esophageal and gastric diseases,21 cases of adenocarcinoma, 16 cases of squamous cell carcinoma,2 cases of adenosquamous carcinoma, 1 cases of mucoepidermoid carcinoma,1 cases of arthritis inflammatory pseudotumor, 1 cases of adenocarcinoma with mucous adenocarcinoma. In the control group, male 24 cases,female 18 cases,the average age is(57.17 ±5.53)years, 10 cases of lung disease,32 cases of esophageal and gastric diseases, 22 cases of adenocarcinoma, 17 cases of squamous cell carcinoma,1 cases of adenosqu- amous carcinoma, 1 cases of mucoepidermoid carcinoma,1 cases of infla- mmatory pseudotumor.Two group of operation patients were performed routine open chest operation.Before surgery,all of the patients were performed the following check:enhanced CT on the head, chest and abdomen, the whole body bone scan,electronic bronchoscope or gastroscope, electrocard- iogram,heart function,pulmonary function and routine preope- rative laboratory tests.All of the patients with preoperative practised cough and sputum.Each case of protection of intercostal nerve surgical operation were performed by fixed physician. The conventional thoracotomy along the upper edge of the next rib get into the chest layer by layer. In the position that need to placed a rib retractor of the last rib, the physician cut the periosteum of the lower edge of the last rib, and stripped the periosteum along the lower edge of the rib with elevator. The length of the incision is as long as the size of the rib retractor, it can protect the intercostal nerve of the lower edge of the last rib. When the physician closed the chest, the noodle firstly pass through the upper edge of the last rib, then let the needle out of the lower edge of the next rib and make the needle be close to the lower edge. Finally, close the chest. All the patients in 1d, 3d, 7d after operation use a visual analogue score on postoperative pain score and as the evaluation index, and observe postoperative patients occurred atelectasis, pulmonary infection and other complications and the long-term incision feeling abnormal situations(around the incision and the incision pain, numbness, burning sensation, etc.). In this study, all data were statistically analyzed by SPSS13.0 software. According to the data type, count data selects chi-square test, for measurement data, the normal and homogeneity choose two independent samples t test, the abnormal selected Mann-Whitney Test.α=0.05.Results:1 The gender composition of patients in the two groups: the experimental group:Male/female=22/20,control group:Male/female=24/18. The difference was not statistically significant.( c2=0.192,P=0.661,chi- square test)2 Statistical analysis of the age of two groups patients are respectively: the age of patients in experimental group is 58.90±6.71 years, the age of patients in the control group is 57.17±5.53 years. The difference was not statistically significant.(t=1.296,P=0.199,t test)3 The composition of the two groups of patients’ disease categories: the proportion of esophageal and cardiac disease is 71.43% in experimental group, the proportion of esophageal and cardiac disease is 76.19% in the control group. The difference was not statistically significant.(c2=0.246, P=0.620, chi-square test)4 Statistical analysis of the two groups patients first days after operative pain score are respectively: experimental group of 2.88±2.09, control group of 6.38±1.90. The difference was statistically significant.(t=-8.040, P<0.001, t test)5 Statistical analysis of the two groups patients third days after operative pain score are respectively: experimental group of 2.71±1.97, 5.83±1.82 in the control group. The difference was statistically significant.(Z=-5.879,P<0.001,Mann-Whitney Test)6 Statistical analysis of the two groups patients seventh days after operative pain score are respectively: experimental group of 2.12±1.55, 4.24 ±1.51 in the control group. The difference was statistically significant.(Z=-5.338, P<0.001, Mann-Whitney Test)7 Statistical analysis of long-term incision feeling abnormal incidence rate of the two groups patients after operative is respectively: the long-term incision feeling abnormal incidence rate was 9.52% in experimental group, the incidence rate of control group is 85.71%. The difference was statistically significant.(c2=48.873, P<0.001, chi-square test)8 Statistical analysis of pneumonia incidence rate of the two groups patients after operative is respectively: the incidence of pneumonia is 9.52% in the experimental group, the incidence of pneumonia is 38.10% in the control group. The difference was statistically significant.( c2=9.450,P= 0.002, chi-square test)9 Statistical analysis of pulmonary atelectasis incidence rate of the two groups patients after operative is respectively: the incidence rate of atelectasis was 2.38% in experimental group, the rate of pulmonary atelectasis was 9.52% in control group. The difference was not statistically significant.(c2=1.914, P=0.167, chi-square test)Conclusion:1 At different time points of postoperation, pain scores of patientswho were used protection of intercostal nerve closure technology were lowerthan those of the conventional closed technology.2 The postoperative pneumonia incidence rate of protection of intercostal nerve closure technology group lower than incidence of the conventional closed low technology group.3 Postoperative long-term incision feeling abnormal incidence rate of protection of intercostal nerve closure technology group lower than the incidence rate of conventional closed technology group.