摘要
目的研究直视下胸椎旁神经阻滞对全麻下胸腔镜下肺叶切术患者术后镇痛效果的影响。方法择期行胸腔镜下叶切除术患者90例,随机分为:静脉自控镇痛(patient controlled intravenous analgesia,PCIA)组(G组),术毕采用静脉自控镇痛;超声引导下胸椎旁神经阻滞复合PCIA组(U组),手术结束后超声引导下行胸椎旁神经阻滞,术毕启动静脉镇痛泵行PCIA;直视下胸椎旁神经阻滞复合PCIA组(E组),手术结束关胸前外科医师直视下行胸椎旁神经阻滞,效果通过测定阻滞范围判断,术毕启动静脉镇痛泵行PCIA。记录完成超声引导下胸椎旁神经阻滞和直视下胸椎旁神经阻滞所需时间;记录胸椎旁神经阻滞后各时间点心率(HR)、血压(BP)、脉搏血氧饱和度(SpO2);记录术后各时间点静息时VAS评分、咳嗽时VAS评分、感觉神经阻滞节段;记录术后48 h静脉自控镇痛泵按压次数;观察术后Ricker躁动评分、恶心、呕吐、皮肤瘙痒、呼吸抑制和肺部并发症发生率。结果与U组比较,E组完成胸椎旁神经阻滞所需时间明显缩短(P<0.05),而两组感觉神经阻滞节段数差异无统计学意义(P>0.05);与G组比较,U组和E组在术后各时间点静息和咳嗽VAS评分明显降低(P<0.05);与U组比较,E组在术后各时间点静息和咳嗽VAS评分差异无统计学意义(P>0.05);与G组比较,U组和E组在术后48 h静脉自控泵按压次数均明显减少(P<0.05);与U组比较,E组在术后48 h PCIA泵按压次数差异无统计学意义(P>0.05)。与本组胸椎旁神经阻滞时比较,U和E组在神经阻滞术后10 min、15min、20 min、30 min各时间点的HR、收缩压(SBP)、舒张压(DBP)均降低(P<0.05);与本组开始关胸时比较,G组在开始关胸后各时间点的HR、SBP、DBP均差异无统计学意义(P>0.05)。与G组比较,U组和E组术后烦躁和肺部并发症发生率明显降低(P<0.05),镇痛满意度明显提高(P<0.05),术后恶心呕吐、嗜睡、呼吸抑制等发生率均差异无统计学意义(P>0.05)。结论直视下胸椎旁神经阻滞可为胸科手术患者术后提供良好的镇痛,其镇痛效果与超声引导下胸椎旁神经阻滞相当,但操作更简单,耗时更短,值得推广。
Objective To assess the effects of open thoracic paravertebral block on postoperative analgesia in patients undergoing open pulmonary lobectomy under general anesthesia.Methods A total of 90 patients withASAscores ofⅠorⅡ,scheduled for open pulmonary lobectomy under propofol-remifentanil total intravenous anaesthesia,were randomly divided into 3 groups(n=30 each)by using a random number table:PCIA group(group G),Ultrasound-guided TPVB combined with PCIA group(group U),and open TPVB combined with PCIA group(group E).In group G,patients received PCIA after the surgery.In group U,TPVB was performed on the operated side under ultrasound guidance with 0.25%ropivacaine 30 mL combined with the PCIA after the surgery.In group E,the TPVB was performed under the direct vision with 0.25%ropivacaine 30 ml combined with the PCIA.The Visual Analogue Score(VAS)at rest and during coughing,the sensory nerve block segment,as well as the respiratory rate were measured and recorded at different time-points.Furthermore,the hemodynamic vital signs at different time-points,the number of successfully delivered doses 48 h after the surgery,as well as the incidence of postoperative complications were also recorded and analyzed.Results Compared with group G,the VAS score,the times of delivered doses,the incidence of agitation and pulmonary complications were lower,the degree of patient’s satisfaction with analgesia was increased in group U and group E(P<0.05).However,the incidence of PONV,respiratory depression had no significant difference between the three groups.Furthermore,there were no significant difference between Group U and group E in the VAS score at different timepoints and the number of successfully delivered doses(P>0.05).Conclusions Open TPVB can provide satisfactory analgesia for patients undergoing open pulmonary lobectomy under general anesthesia,and the analgesia efficacy is equivalent to the TPVB under ultrasound guidance.In addition,open TPVB is easier to operate,which should be popularized.
作者
周银燕
张宇
白文娅
沈艳娟
邵建林
赵国良
ZHOU Yin-yan;ZHANG Yu;BAI Wen-ya;SHEN Yan-juan;SHAO Jian-lin;ZHAO Guo-liang(Dept.of Anesthesiology,The 1st Affiliated Hospital of Kunming Medical University,Kunming Medical Unversity,Kunming Yunnan 650032,China)
出处
《昆明医科大学学报》
CAS
2020年第7期64-70,共7页
Journal of Kunming Medical University
基金
云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目[2017FE468(-034)]
院士专家工作站(2017IC043)。
关键词
胸椎旁神经阻滞
术后镇痛
肺叶切除术
Thoracic paravertebral block
Postoperative analgesia
Pulmonary lobectomy
