超声引导下椎旁神经阻滞应用于肺叶切除患者的临床观察

Clinical Observation of Ultrasound Guided Paravertebral Nerve Block for Patients Underwent Pulmonary Lobectomy

目的：观察超声引导下椎旁神经阻滞对肺叶切除患者血流动力学、镇痛效果、炎性指标的影响及安全性。方法：选择我院择期行肺叶切除术的患者72例,按随机数字表法分为观察组和对照组,各36例。两组患者均行气管插管全身麻醉,术中维持脑电双频指数40-60。对照组患者术前10 min给予舒芬太尼0.1μg/kg,镇痛方案：舒芬太尼1.0μg/ml,速度2 ml/h,自控2.5 ml/次,自控时间间隔15 min;观察组患者术前行超声引导下椎旁神经阻滞,手术结束前10 min经椎旁间隙阻滞留置导管给予0.2%罗哌卡因15 ml,镇痛方案：0.2%罗哌卡因100 ml,速度2 ml/h,自控2.5 ml/次,自控时间间隔15 min。观察两组患者手术前后血流动力学指标、炎性指标、术后视觉模拟（VAS）评分及不良反应发生率。结果：观察组患者拔管后30 min及术后6、12 h心率（HR）明显低于对照组,拔管后30 min及术后6 h平均动脉压（MAP）明显低于对照组,差异均有统计学意义（P〈0.05）。两组患者术后24、48 h HR及术后12、24、48 h MAP比较,差异均无统计学意义（P〉0.05）。拔管后30 min及术后6、12、24 h,观察组患者VAS评分明显低于对照组,差异有统计学意义（P〈0.05）;术后48 h两组患者VAS评分比较,差异无统计学意义（P〉0.05）。拔管后30 min及术后6、12、24、48 h,观察组患者血浆白细胞介素（IL）6、肿瘤坏死因子α水平显著低于对照组,血浆IL-10水平显著高于对照组,差异有统计学意义（P〈0.05）。观察组患者不良反应发生率为11.1%,显著低于对照组的33.3%,差异有统计学意义（P〈0.05）。结论：超声引导下椎旁神经阻滞对肺叶切除患者术后镇痛效果较好,血流动力学稳定,可有效降低患者术后炎症反应,且不良反应发生率低。

OBJECTIVE：To observe the effects and safety of ultrasound guided paravertebral nerve block on hemodynamics,analgesic effect and inflammatory index in patients underwent pulmonary lobectomy. METHODS：72 patients underwent selective pulmonary lobectomy in our hospital were randomly divided into observation group and control group,with 36 cases in each group.All patients were given endotracheal intubation general anesthesia and maintain BIS 40-60. Control group was given sulfentanyl 0.1μg/kg 10 min for intravenous analgesia pump before operation,and sulfentanyl 1.0 μg/ml,at 2 ml/h,2.5 ml/time for self-control,self-control interval of 15 min. Observation group underwent ultrasound guided paravertebral nerve block before operation,and given 0.2% ropivacaine 15 ml via paravertebral block indwelling catheter for analgesia pump,analgesia regimen：0.2% ropivacaine,at 2 ml/h,2.5 ml/time for self-control,self-control interval of 15 min. Hemodynamic index,inflammatory index,VAS and the incidence of ADR were observed in 2 groups before and after operation. RESULTS：The HR of observation group was significantly lower than that of control group 30 min after extubation,6 and 12 h after operation,with statistical significance（P〈0.05）. There was no statistical significance in HR 24 and 48 h after operation and MAP 12,24 and 48 h after operation,without statistical significance（P〉0.05）. VAS of observation group was significantly lower than that of control group 30 min after extubation,6,12 and24 h after operation,with statistical significance（P〈0.05）. There was no statistical significance in VAS between 2 groups 48 h after operation（P〉0.05）. Plasma IL-6 and TNF-α level of observation group were significantly lower than those of control group,but plasma IL-10 level was significantly higher than control group 30 min after extubation,6,12 and 24 h after operation,with statistical significance（P〈0.05）. The incidence of ADR was 11.1% in observation group,which was significantly lower than 33.3%of control group,with statistical significance（P〈0.05）. CONCLUSIONS：Ultrasound guided paravertebral nerve block shows good postoperative analgesia effect in patients underwent pulmonary lobectomy,keep hemodynamics stable and effectively reduce postoperative inflammatory reaction with low incidence of ADR.