小儿电视胸腔镜术后超声引导下椎旁神经阻滞的镇痛效果

Analgesic effect of ultrasound-guided paravertebral nerve block after video-assisted thoracoscopic surgery in children

目的探讨超声引导下椎旁神经阻滞应用于小儿电视胸腔镜(VATS)术后镇痛的效果,以期为临床上VATS术后镇痛方案的选择提供依据。方法选择惠州市妇幼保健计划生育服务中心2017年1月至2018年6月期间收治的38例采用VATS治疗的胸部外科疾病患儿为研究对象,根据随机数表法分为观察组和对照组,每组19例,对照组术后使用静脉自控镇痛泵(PCIA)镇痛,观察组在对照组基础上应用超声引导下椎旁神经阻滞。比较两组患儿拔管后不同时间点FLACC镇痛评分及Ramsay镇静评分,并比较两组患儿24 h PCIA按压次数。记录观察组患儿发生并发症情况。结果观察组患儿拔管后1 h、6 h、12 h FLACC镇痛评分分别为(2.97±0.28)分、(2.56±0.69)分、(2.28±0.52)分,均明显低于对照组的(3.41±0.72)分、(3.19±1.01)分、(3.06±0.93)分,差异均具有统计学意义(P<0.05);观察组患儿拔管后1 h、6 h、12 h Ramsay评分分别为(1.92±0.38)分、(2.03±0.26)分、(2.18±0.19)分,均明显低于对照组的(2.38±0.56)分、(2.29±0.35)分、(2.41±0.25)分,差异均具有统计学意义(P<0.05);观察组患儿24 h内镇痛泵按压次数为(4.3±1.6)次,明显低于对照组的(6.4±2.1)次,差异具有统计学意义(P<0.05);观察组未发生穿刺相关及局麻药毒性反应等并发症。结论超声引导下椎旁神经阻滞应用于小儿电视胸腔镜手术后具有良好的镇痛、镇静效果,且安全性高。

Objective To investigate the effect of ultrasound-guided paravertebral nerve block on postoperative analgesia after video-assisted thoracoscopic surgery(VATS) in children, in order to provide a basis for the selection of postoperative analgesic schemes after VATS. Methods A total of 38 children with thoracic surgical diseases who were treated with VATS in Huizhou Maternal and Child Health Care and Family Planning Service Center from January2017 to June 2018 were selected as the subjects. According to the random number table method, they were divided into an observation group and a control group, with 19 cases in each group. The control group was treated with intravenous patient controlled intravenous analgesia(PCIA) for analgesia, and the observation group was applied ultrasound-guided paravertebral nerve block on the basis of the control group. The FLACC analgesia score and Ramsay sedation score at different time points after extubation were compared between the two groups, and the number of 24 h PCIA compressions in the two groups was compared. The complication of the observation group was recorded. Results After extubation, the FLACC analgesic scores at 1 h, 6 h and 12 h in the observation group were respectively 2.97±0.28, 2.56±0.69,and 2.28±0.52, which were significantly lower than corresponding 3.41±0.72, 3.19±1.01, and 3.06±0.93 in the control group, and all differences were statistically significant(P<0.05). The Ramsay scores at 1 h, 6 h and 12 h after extubation in the observation group were respectively 1.92±0.38, 2.03±0.26, and 2.18±0.19, which were significantly lower than corresponding 2.38±0.56, 2.29±0.35, and 2.41±0.25 in the control group, and all differences were statistically significant(P<0.05). The number of analgesic pump presses in the children of the observation group was 4.3±1.6, which was significantly lower than 6.4±2.1 in the control group, and the difference was statistically significant(P<0.05). No puncture related and local anesthetic toxicity and other complications were occurred in the observation group. Conclusion Ultrasound-guided paravertebral nerve block has good analgesic and sedative effects after video-assisted thoracoscopic surgery in children, and it has high security.