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The Experiment Study on Intercostal Nerve Functional Recovery and Clinical Study on the Effect of Relieving Pain of ICNF

Author: LiShanCheng
Tutor: LuZhaoTong
School: Taishan Medical College
Course: Surgery
Keywords: Intercostal nerve freezing Relieve pain Freezing time CMAP Animal experiments Clinical Research
CLC: R614
Type: Master's thesis
Year: 2007
Downloads: 4
Quote: 0
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Abstract


Objective: In this study, the first part of the animal experiments: intercostal nerve temperature different freezing time frozen rabbits with the same determination of the freezing of the intercostal nerve at different times in the frozen compound muscle action potential (CMAP), and observed functional recovery compare different freezing time the impact of differences in their functional recovery, Thoracic Surgery intercostal nerve freezing (ICNF) analgesic provide a theoretical basis and guide appropriate clinical choice freezing time; second part of clinical research: frozen with commonly used clinical cases of intercostal nerve 90s the not frozen Case control study to investigate the the intercostal nerve frozen analgesic effect and its clinical significance. Methods: 1. Animal experiments: 28 rabbits by freezing time randomly divided into four groups, namely 30s group and 60s group group, 90s and 120s group 7. Measured before freezing each rabbit 9th intercostal nerve CMAP, recording its latency and amplitude of the next area, and calculate the normal mean. 9th intercostal nerve dissection rabbits in each group, respectively, the Maiwand freezing probe cryotherapy instrument in liquid C02 as air-conditioners source frozen. Frozen head temperature of -50 ℃ ~ -70 ℃. Freezing time, respectively, by grouping Frozen 30s, 60s, 90s and 120s. Frozen different time measurement section 9 intercostal nerve CMAP, for comparison with the normal mean observed its recovery, and the respective frozen group pairwise comparison, to observe whether a significant difference; 2 Clinical study: After selecting a standard The lateral thoracotomy 150 patients, aged 22 -78 years, mean 56.5 years. Were randomly divided into two groups: 50 cases of frozen set of 100 patients in the control group (non-frozen group). The surgical procedure included: esophagectomy and gastric cardia resection, lobectomy. Off his chest an intercostal incision, and up and down and placed pleural drainage tube intercostal nerve roots freed at the end of surgery, freezing probe placed on frozen Curran K320 cryosurgery treatment machine. Liquid CO2 as air-conditioning source, the freezing temperature is -50 ° C to -70 ° C, the the refrigerating duration of 90s. Observed and compared after chest pain based on the visual analog scale (visual analogue scales, VAS) rating: 0 painless, 1 to 2 occasional mild pain, often 3 to 4 ,5-6 mild pain occasionally obvious pain but tolerable, often obvious pain but still put up 7 to 8, 9 to 10 pain and morphine consumption record of two groups of patients, the average length of hospital stay, observe whether a significant difference. Results: 1 animal experiments: (1) in each group of rabbits 9th intercostal nerve freezing before the change of electrical stimulation: stimulus rabbits were not frozen intercostal nerve stimulus current can induce a rib interosseous muscle contraction, due to individual differences to maintain stimulus current intensity stimulation frequencies between 18.6-28.6mA 1 / s, can record the intercostal nerve CMAP evoked potential / EMG measuring system (MEB-9200K) waveform latency and amplitude of the area under the data. Calculated by statistical software available CMAP latency and amplitude of the area under the normal mean of 5.17 ± 0.75ms and 8.37 ± 0.55mv. (2) frozen 30s rabbits in the freezer after changes in different times of the 9th intercostal nerve CMAP: frozen the 30s instantly and frozen one day intercostal nerve CMAP waveform all disappear, increasing the current intensity and stimulation frequency waveform leads ; 3 days after freezing can be measured to the intercostal nerve CMAP, and can record its latency and amplitude of the area under the data, the mean values ??of 1.98 ± 0.12ms and 10.14 ± 1.26mv,; With time frozen extend intercostal nerve CMAP gradually restored, and that the incubation period is gradually shorten, gradually increasing volatility of the area under the 30 days, but has not yet returned to normal levels. (3) Frozen 60s and 90s group rabbits frozen at different times after the ninth intercostal nerve CMAP changes: Frozen 60s immediately frozen one day, three days intercostal nerve CMAP waveforms are disappear, increasing the current strength and stimulation frequency waveform leads; 7 days after freezing can be measured to the intercostal nerve CMAP, and can record the latency and amplitude of the area under the data, mean 1.04 ± 0.24ms and 14.11 ± 1.34mv, respectively; frozen 90s instantly. frozen one day, three days intercostal nerve CMAP waveform are disappear, increasing the current intensity and stimulation frequency waveform leads; 7 days after freezing can be measured to the intercostal nerve CMAP, can record its latency and amplitude area data, the mean, respectively 1.00 ± 0.37ms and 15.52 ± 1.27mv, respectively; With frozen after time extend the 60s and 90s group intercostal nerve CMAP gradually restored, ie incubation period gradually shortened, the volatility of the area under the gradually increasing, but neither returned to normal levels within 30 days. (4) Frozen 120s rabbits frozen at different times after the ninth intercostal nerve CMAP changes: freeze-120s immediately frozen after 1 day, 3 days, 7 days and 10 days intercostal nerve CMAP waveform disappeared, increased current intensity and stimulation frequency waveform leads; frozen after 15 days can be measured to the intercostal nerve of CMAP parameters from APB and recording its latency and amplitude of the area under the data mean 1.35 ± 0.22ms and 23.19 ± 1.06mv; With significantly prolonged frozen after time intercostal nerve CMAP gradually restored, and that the incubation period gradually shortened gradually increasing volatility of the area under the 30 days, but did not recover to normal levels. (5) between the groups, the latency and amplitude under the area of ??numerical pairwise comparison results: the 28 rabbits 9th intercostal nerve CMAP latency, amplitude, area under the normal mean of 5.17 ± 0.75ms and 8.37 ± 0.55mv; the various frozen group with normal mean were significant difference (P lt; 0.05); 30S group, respectively, with the 60S group, 90S group, 120S group of CMAP recovery there is significant with difference (P lt; 0.05); 60s group and 90s group The CMAP recovery no obvious differences (incubation period comparison P = 0.715; volatility under the area of ??comparative P = 0.873); 60s group and 120S group of CMAP recovery there is significant with difference (P lt; 0.05); 90S group with 120s group of CMAP recovery have significant difference (latency comparison P = 0.000; volatility of the area under the comparison P = 0.029). 0 of 2. Clinical research: frozen group 25 patients (25%), 1-2 58 patients (58%) ,3-four patients (7%) ,5-6 (5%), 7 -8 Grade 3 patients (3%) ,9-10 (2%), total analgesic efficiency (0-6) to 95%, the average VAS score of 2.56 points, which is completely painless 25%, slightly pain 58%; 0 of the control group and grade 1-2 cases ,3-4 in 6 patients (12%), 5-six patients (18%) ,7-eight of 15 patients (30%), 9 -10 in 20 cases (40%), analgesics effective rate of 30%, the average VAS score of 7.34 points. Two sets of analgesic efficiency is a significant difference (P = 0.000), VAS score very significant difference (P = 0.000). Frozen morphine consumption after freezing group average 3.2mg, control group average 7.6mg, there is a significant difference (P = 0.000). Average hospital stay of 14.5 days of freezing group, the control group, 18 days, there is a significant difference (P = 0.037) Conclusion: 1, animal experiments show that: (1) at -50 ° C to -70 ° C frozen intercostal nerves need to continue for a certain frozen The time to achieve the purpose of blocking nerve conduction function, the freezing time is different, the different rates of recovery of neurological function. The corresponding analgesic effect there will be difference. (2) at -50 ° C to -70 ° C freezer 30s function of intercostal nerve instantly disappear, so as to achieve the purpose of pain, intercostal nerve freezing analgesic clinical functional learning on the theoretical basis. (3) at -50 ° C to -70 ° C intercostal nerve freezing 30s, 60s, 90s, and 120s, intercostal nerve conduction function can be gradually restored, the longer frozen, intercostal nerve conduction, the slower recovery. (4) commonly used in clinical Frozen 90s, made good analgesic effect. The experimental results show that the frozen 60s and 90s intercostal nerve function recovery was no significant difference. On the basis of pain relief and functional recovery, choose frozen suitable for 60s. 2 clinical studies: intercostal nerve freezing is an effective analgesic dose of pain medications, significantly reduce patients frozen applications, shorter hospital stays, and is conducive to the patient's respiratory function recovery and improved quality of life in the frozen Thoracic Surgery. Intercostal nerve freezing operation is simple, safe and effective, there is a strong application value.

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CLC: > Medicine, health > Surgery > Surgical operation > Anesthesiology
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