剖胸术中脊柱旁间隙置管术后镇痛的观察

Obeservation of Postoperative Analgesia by means of Paravertebral Space Catheterization during the Thoracotomy

目的 探讨胸部手术后镇痛的新方法。方法 剖胸术中采用直视下经壁层胸膜穿孔脊柱旁间隙置管单侧多根肋间神经连续阻滞术。将５６ 例胸外科择期手术病人随机分为两组，各２８ 例。结果 两组镇痛有效率分别为８２．２ ％ 和９６．４ ％ ，镇痛显效时间为２．３５ ±０．８６ 分钟，维持时间Ⅱ组（３ ～５ 天） 明显长于Ⅰ组（３９１．２０ ±１２０．６９ 分钟）（ Ｐ＜０．０１） 。镇痛前后呼吸功能明显改善（ Ｐ＜ ０．０５） 。结论 该方法能长时间保留镇痛管重复或连续注药，镇痛效果好，作用快，持续时间长，简单易行，安全可靠，无并发症及毒副作用。

Objective To approach new ways of pain relief procedures. Methods 56 patients having undergone selective thoracotomy by means of new analgesic method of unilateral, several and continuous intercostal nerver block by extrapleuralcatheterization in paravertebral space during the operation, were randomly divided into 2 group ( n =28). Results The rate of satisfacatory analgesia in groups Ⅰand Ⅱ were 82.20% and 96.40%. The average analgesia-occuring time (OT) was 2.35±0.86 minutes. The lasting time (LT) was remarkbly longer in group Ⅱ(3～5 days) than in group Ⅰ(391.20±120.69 minutes) ( P <0 01). After the pain relief, fdecreased, Vt and Mv increased ( P <0 05). Conclusions The technique described here can quickly and effectively relieve pain by repeated or continuous infusion through a long-term indwelling analgesic catheter, and it is a simple and easily applied, safe and reliable method of providing analgesia without any side effets and complications related to the catheterication. [