探讨超声引导下椎旁神经阻滞在老年患者开胸手术术中及术后的镇痛效果

Under ultrasound guided by the vertebral nerve block open chest surgery in elderly patients with intraoperativeand postoperative analgesia effect

目的 研究超声引导下椎旁神经阻滞在老年患者开胸手术术中及术后的镇痛效果.方法 以我院2013年10月-2015年10月收治的40例胸手术患者为研究对象,随机平分为基本资料无统计学差异的观察组和对照组,各20例.对照组采用全身麻醉,术中采用丙泊酚、芬太尼、苯磺顺阿曲库铵等行静脉注射,以维持麻醉深度.术后单纯采用静脉自控镇痛（PCIA）镇痛;观察组采用超声引导下行胸椎旁神经阻滞复合PCIA镇痛,超声引导下椎旁神经阻滞完成后行全身麻醉及术后PCIA镇痛,操作与对照组相同.对比两组的术中及术后48h内PCIA用药量,术后2、4、6、8、24、48h的疼痛评分以及并发症情况.结果 观察组的用药量、术后各时段的疼痛评分以及并发症总发生率均显著低于对照组,差异均具有统计学意义（P〈0.05）.结论 在老年患者开胸手术中采用超声引导下椎旁神经阻滞的方式,能有效减少患者的术中及术后48h内PCIA用药量,且术中及术后的镇痛效果提高,总并发症的发生率降低,是对老年患者安全有效方式.

objective to study the ultrasound guided by the vertebral nerve block open chest surgery in elderly patients with intraoperative andpostoperative analgesia effect. Methods our hospital in October 2013 and October 2013-40 cases of thoracic surgery patients as the research object, andrandomly divide as the basic data of no statistical differences between the observation group and control group, 20 cases each. The control group with generalanesthesia, intraoperative use of propofol, fentanyl and benzene sulfonic shun atracurium intravenous line, in order to maintain anesthesia depth. Only withpostoperative intravenous self-control analgesia （PCIA）; Observation group adopts composite PCIA analgesia by descending thoracic nerve block guided byultrasound, ultrasound guided by the vertebral nerve block completed after general anesthesia and postoperative PCIA analgesia, operation is the same as thecontrol group. Compared to two groups within 48 h of intraoperative and postoperative PCIA dose, 2, 4, 6, 8, 24 and 48 h pain score and complications.Results observation group dose in each period, postoperative pain score and the total incidence of complications were significantly lower than the controlgroup, the differences were statistically significant （P 〈 0.05）. Conclusion open heart surgery in elderly patients with ultrasonic guided by the vertebral nerveblock in the way, can effectively reduce the number of patients with intraoperative and postoperative PCIA within 48 h dose, and intraoperative andpostoperative analgesia effect, reduce the incidence of total complications, is safe and effective for elderly patients.