超声引导下改良胸骨旁阻滞在纵隔占位正中开胸手术中的应用研究

Application of ultrasound-guided modified parasternal block in mediastinal space-occupying median thoracotomy

目的观察超声引导下改良胸骨旁阻滞在纵隔占位正中开胸手术中临床应用效果。方法择期行正中开胸手术患者60例,随机数字表法分为I组(对照组)和Ⅱ组(胸骨旁阻滞组)各30例。入室后,I组第三及第五肋软骨左右侧各给予0.9%生理盐水10 ml;Ⅱ组同I组位置各点给予0.375%罗哌卡因10ml。全凭静脉诱导后插入气管导管,术中静脉麻醉维持;比较两组患者入室时静息状态下(T0)、气管插管时(T1)、切皮时(T2)、拔管前(T3)心率及平均动脉压变化。两组均在术毕连接静脉自控镇痛泵。分别记录两组患者拔管后即刻及拔管后2、6、12、24、48 h Ramsay评分和NRS评分,镇痛泵首次PCA时间、术后有效PCA次数、口服镇痛药补救人次及麻醉相关并发症的发生率。结果Ⅱ组患者T2、T3心率血压变化小于I组,拔管后即刻、拔管后2 h及拔管后6 h的NRS评分,拔管后即刻Ramsay评分显著小于I组;首次PCA时间长于I组,且术后PCA次数、补救次数均少于I组,差异均有统计学意义(P<0.05);两组患者麻醉并发症发生率比较,差异无统计学意义(P>0.05)。结论全身麻醉中复合应用改良胸骨旁阻滞有良好的围术期镇痛效果,有一定的临床应用价值。

Objective To observe the clinical application effect of ultrasound-guided modified parasternal block in mediastinal space-occupying median thoracotomy.Methods Sixty patients undergoing median thoracotomy were divided into a group I(control group)and a groupⅡ(modified parasternal block group),30 in each group.The group I was given 10 ml of 0.9%normal saline on the left and right sides of the third and fifth costal cartilages.The group II was given 10 ml of 0.375%ropivacaine at the same position as the group I.The endotracheal tube was inserted after total intravenous induction,and intravenous anesthesia was maintained during the operation.The changes of heart rate and mean arterial pressure at rest(T0),during endotracheal intubation(T1),during skin incision(T2)and before removing the endotracheal tube(T3)were recorded.Both groups were connected to intravenous analgesic pump after operation.The NRS score and the Ramsay score immediately after extubation and after 2,6,12,24 and 48 hours of extubation were observed in the two groups.The first time of patient controlled analgesia(PCA)using analgesic pump,the numbers of effective postoperative PCA,the times of oral analgesic rescue and the incidence of anesthesia-related complications were recorded.Results The changes of heart rate and blood pressure at T2 and T3 in the group II were less than those in the group I.The NRS score immediately after extubation,after 2 and 6 hours of extubation,and the Ramsay score immediately after extubation in the group II were significantly lower than those in the group I.The first PCA time was longer and the numbers of postoperative PCA and rescue times in the group II were less than those in the group I(P<0.05).There was no significant difference in the incidence of anesthesia complications between the two groups(P>0.05).Conclusion Combined application of modified parasternal block in general anesthesia has obvious perioperative analgesia effects and a certain clinical value.