双侧胸椎旁神经阻滞对肺癌根治术患者术后镇痛效果影响

Effects of bilateral thoracic paravertebral block on postoperative analgesia in patients undergoing radical for lung cancer

目的探讨全麻复合双侧胸椎旁神经阻滞（TVPB）对肺癌根治术患者术后镇痛效果的影响。方法选取择期拟在全身麻醉下行肺癌根治术的患者60例作为研究对象。采用随机数字表法,将患者随机分为单纯全麻组（G组）和双侧胸椎旁神经阻滞复合全麻组（GP组）,每组30例。两组患者均选择静脉麻醉诱导气管插管,麻醉维持采用静脉吸入复合麻醉。GP组于麻醉诱导前在神经刺激器引导下行双侧T4~T5椎旁神经阻滞,两侧分别给予0.5%罗哌卡因15 ml,G组不给予上述处理。术毕,两组患者均使用舒芬太尼自控静脉镇痛,维持视觉模拟评分（VAS）≤3分,当VAS评分〉3分时,则静脉给予吗啡。分别于术后2、6、12、24、48 h行布氏舒适度评分（BCS）,记录患者术后24 h舒芬太尼用量、患者自控静脉（PCIA）泵按压次数、吗啡用量,并观察患者术后不良反应（恶心、呕吐、嗜睡、皮肤瘙痒及呼吸抑制）的发生情况。结果与G组比较,GP组患者术后各时点BCS舒适度评分均升高,术后24 h舒芬太尼用量、PCIA泵按压次数及吗啡用量均减少（P〈0.05）。G组患者术后出现恶心12例,呕吐8例,嗜睡5例,皮肤瘙痒2例,未出现呼吸抑制;GP组患者术后出现恶心6例,呕吐3例,未出现嗜睡、皮肤瘙痒及呼吸抑制。结论与单纯全麻比较,术前行双侧胸椎旁神经阻滞复合全麻用于肺癌根治术患者术后镇痛效果更佳,并可降低术后不良反应的发生率。

Objective To investigate the effects of bilateral thoracic paravertebral block on postoperative analgesia in patients undergoing radical for lung cancer. Methods Sixty patients who underwent radical for lung cancer under general anesthesia were randomly divided into two groups（ n = 30） ： general anesthesia group（ Group G） and general anesthesia combined with bilateral thoracic paravertebral block group（ Group GP）. The patients were performed under general anesthesia with endotracheal tube in both groups. The patients in Group GP were received bilateral thoracic paravertebral block guided by nerve stimulator before anesthesia induction,which were performed with 15 ml of 0. 5% ropivacaine in single side. And the patients in Group G were not given nerve block. The patients received patient-controlled intravenous analgesia（ PCIA） with sufentanil after surgery,the VAS score was maintained less than 3. If VAS score was more than 3,morphine was injected. The comfort level was evaluated with BCS at 2,6,12,24 and 48 hours after operation. The consumption of sufentanil within 24 hours after operation,the times of PCIA bolus infusion and the usage of morphine were recorded,and the postoperative adverse reactions（ nausea,vomiting,lethargy,itchy skin and respiratory depression） were also observed and recorded. Results Compared with Group G,the BCS was increased,the consumption of sufentanil within 24 hours after operation,the times of PCIA bolus infusion and the usage of morphine were decreased in group GP（ P〈0. 05）. In Group G,there were 12,8,5,2 patients occuring nausea,vomiting,lethargy and itchy skin,respectively. But there was no patients appearing respiratory depression. And in Group GP,there were 6 and 3 patients occuring nausea and vomiting,respectively. But there was no patients appearing lethargy,itchy skin and respiratory depression. Conclusion Bilateral thoracic paravertebral block before operation can enhance postoperative analgesia in patients undergoing radical for lung cancer at the postoperative period and can reduce the incidence of postoperative adverse reactions.