单点胸椎旁神经阻滞联合静脉自控镇痛对胸科手术患者术后镇痛效果的影响

Effects of Single-Injection Thoracic Paravertebral Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia after Thoracic Surgery

目的：评估超声引导下单点胸椎旁神经阻滞（single-injection thoracic panavertebral block,TPVB）联合静脉自控镇痛（patient-controlled intravenous analgesia,PCIA）对胸科手术患者术后镇痛效果。方法：将90例美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级胸科手术患者术后随机分为行TPVB联合PCIA组（观察组）和行PCIA组（对照组）,各45例。观察、记录比较术后1、12、24、48 h患者的视觉模拟评分（VAS评分）、Ramsay镇静评分以及恶心（呕吐）、皮肤瘙痒、胸闷的发生情况及恶心呕吐评分。结果：观察组患者在静止和咳嗽状态各个时间点VAS评分均显著低于对照组（P〈0.05）;2组患者镇静评分差异无统计学意义（P〉0.05）;观察组患者手术后恶心、呕吐的发生率明显低于对照组（P〈0.05）,同时恶心、呕吐评分明显低于对照组（P〈0.05）。结论：TPVB联合PCIA可以明显缓解开胸手术术后的疼痛刺激,有利于患者肺部功能的恢复和基础疾病的治疗效果的改善,同时可以明显降低并发症的发生率。

Objective： To compare the effect of single-injection thoracic paravertebral block （TPVB） guided by ultrasound com- bined with patient-controlled intravenous analgesia （PCIA） on postoperative analgesia after thoracic surgery. Methods： A total of 90 patients, American Society of Anesthesiologists （ASA）Ⅰ -Ⅱ , undergoing thoracic surgery were divided into observation group and control group random]y, 45 patients in each. The observation group received TPVB combined with PCIA and the control group re- ceived PCIA. The pain grade was evaluated with visual analogue scale （VAS） and Ramsay score at 1, 12, 24, 48 hafler operation were compared. Results： The VAS score in the rest and coughs in the observation group was significantly lower than that in the con- trol group （P〈0. 05）. There was no significant difference in sedation scores in the two groups （P〉0. 05）. The rate of nausea, vom- iting in the observation group were significantly lower than that in the control group （ P〈0. 05） and the score of nausea and vomiting in the obse~＇vatiou group was lower than that in the control group （ P〈0.05 ）. Conclusions ： TPVB guided by ultrasound combined with PCIA is a better analgesic method than only PCIA.