超声引导椎旁神经阻滞用于开胸术后镇痛效果的比较

Effects of ultrasound-guided paravertebral nerve block,parecoxib and flurbiprofen on analgesia after thoracotomy

目的观察超声引导椎旁神经阻滞用于开胸术后的镇痛效果。方法 120例择期行开胸手术的患者随机均分为:超声引导椎旁神经阻滞组(N组)、帕瑞昔布钠组(T组)、氟比洛芬酯组(K组)和空白对照组(C组)。N组手术结束后分别在T4和T8水平进行椎旁神经阻滞,在超声图像的引导下确认针头末端位于椎旁间隙内,推注0.25%罗哌卡因10ml;手术结束前30min,T组静注帕瑞昔布钠40mg;K组静注氟比洛芬酯50mg;C组静注生理盐水5ml。观察并记录术后1、4、16、24、48h的HR、SBP、DBP、RR、SpO2和VAS评分;记录术后1、4、16和24h的Ramsay评分、舒芬太尼用量;观察术后患者恶心呕吐、出汗、眩晕、呼吸抑制、皮肤瘙痒和尿潴留不良反应。结果术后各时点HR、SBP、DBP、RR和SpO2差异均无统计学意义。与C组比较,术后1、4、16、24和48hN组、T组和K组VAS评分明显降低(P<0.05);与N组比较,术后1、4hT组和K组的VAS评分明显升高(P<0.05)。四组患者术后1、4、16和24hRamsay评分差异无统计学意义。术后4、16和24hN组、T组和K组舒芬太尼用量明显减少(P<0.05);四组患者恶心呕吐、出汗、眩晕和呼吸抑制的发生率差异均无统计意义。结论超声引导椎旁神经阻滞可显著减轻开胸术后疼痛,并且在控制术后4h内的疼痛方面的作用优于帕瑞昔布钠和氟比洛芬酯,三种方法均可获得较好的术后镇痛效果,并可减少舒芬太尼的用量。

Objective To observe the analgesic effect of ultrasound-guided paravertebral nerve block after thoracotomy, to compare it with parecoxib and flurbiprofen, and to observe whether these three methods can reduce the drug consumption of sufentanil. Methods One hundred and twenty patients received elective thoracotomy surgery were randomly divided into four groups： ultrasoundguided paravertebral nerve block group（group N）, parecoxib sodium group（group T）, flurbiprofen group（group K）, and control group（group C）. Patients in four groups were all received patientcontrolled analgesia with intravenous sufentanil immediately when they were awake. The VAS pain scores, vital signs, Ramsay sores, sufentanil consumptions, at 1,4,16,24,28,48 h postoperatively were recorded. The side effects, such as nausea, vomiting, dizziness, respiratory depression, pruritus and urinary retention were recorded. Results The VAS scores in group N, group T and group K at every time points were significantly lower than the scores in group C（P〈0. 05）. The VAS scores in group N at I h, 4 h postoperatively were significantly lower than those in group T and group K（P〈0. 05）. The sufentanil consumption in group N, group T and group K at every time points were significantly lower than those in group C （P 〈 0. 05 ）. Conclusion Ultrasound-guided paravertebral nerve block can significantly reduce the post-thoracotomy pain, and its function in controlling the pain within 4 hours after thoracotomy is better than parecoxib and flurbiprofen. Three methods can all get satisfactory analgesic effects and can decrease the consumption of sufentanil.