单次胸椎旁阻滞联合持续胸椎旁阻滞在开胸肺叶切除术后的镇痛效果

Analgesic efficacay of single-injection combined continuous thoracic paravertebral block in patients with lung cancer undergoing open lobectomy

目的观察超声引导下单次胸椎旁阻滞(TPVB)联合持续TPVB在肺癌开胸肺叶切除术后的镇痛效果。方法 60例行开胸肺叶切除术患者,随机分为两组,每组30例。两组术前均给予0.5%罗哌卡因20ml行单次TPVB,SC组术中以0.2%罗哌卡因5ml/h持续泵注行TPVB,SP组术后行舒芬太尼PCIA。记录术后1、6、12、18、24、48h的VAS疼痛评分,患者满意度及不良反应发生情况。结果术后18、24、48h,SP组VAS评分明显高于SC组(P<0.01)。SC组患者镇痛效果满意率为87%,明显高于SP组的63%(P<0.05)。SC组和SP组各有1例(3.3%)呕吐。SP组有1例嗜睡。两组均无一例呼吸抑制发生。结论与单次TPVB联合PCIA相比,超声引导下单次TPVB联合持续TPVB在开胸肺叶切除术后镇痛效果更好,不良反应更少,患者满意度更高。

Objective To evaluate the analgesic efficacy of single-injection combined continuous thoracic paravertebral block （TPVB） in patients with lung cancer undergoing open lobectomy. Methods Sixty patients who underwent open lobectomy were given ultrasound-guided singleqniection TPVB with 20 ml of 0.5 % ropivacaine preoperatively and were randomly assigned to received continuous TPVB analgesia with 0.2% ropivacaine （group SC, n=30） or postoperative PCIA analgesia with 100μg of sufentanil （group SP, n=30）. VAS scores at 1, 6, 12, 18, 24, and 48 h postoperatively were compared between the two groups. Patient satisfaction and adverse effects were evaluated. Results Similar VAS were shown between group SC and group SP at 1, 6 and 12 h postoperatively, while group SC was associated with lower VAS at 18, 24 and 48 h postoperatively than group SP （P 〈0.01）. Patients in group SC were more satisfied in analgesia efficacy （87% vs. 63%, P〈0.05）. One patient in each group experienced vomiting and 1 patient experienced sedation in group SP. No respiratory depression occurred in all patients. Conclusion For patients with lung cancer undergoing open lobectomy, ultrasound-guided single-injection combined continuous TPVB presented better postoperative analgesia and greater patient satisfaction compared with sing-injection TPVB combined with PCIA.