探讨超声引导下单次胸椎旁阻滞联合持续胸椎旁阻滞在肺癌开胸肺叶切除术后的镇痛效果

The analgesic effect of ultrasound guided thoracic paravertebral block combined with TPVB for lung cancer patients after pulmonary lobectomy

目的探讨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。方法选择100例行开胸肺叶切除术的肺癌患者,随机将其分为观察者与对照组各50例。观察组采用超声引导下单次胸椎旁阻滞联合持续TPVB复合全麻,对照组采用神经刺激器引导胸椎旁神经阻滞复合全麻。比较两组患者穿刺不良事件发生率,术后静息及咳嗽时的疼痛评分(VAS评分)及术后并发症情况。结果 1观察组针道调整次数、遇到骨质次数,平均穿刺时间均低于对照组,差异有统计学意义(P<0.05);2观察组术后12 h、24 h、48 h静息状态与咳嗽状态VAS评分均低于对照组,两组比较差异有统计学意义(P<0.05);3观察组术后并发症发生率为4.0%,低于对照组的10.0%,比较差异有统计学意义(P<0.05)。结论超声引导下单次TPVB联合持续TPVB应用于肺癌开胸肺叶切除术安全性高,术后疼痛程度轻。

Objective To explore the analgesic value of ultrasound guided single thoracic paravertebral block combined with TPVB for lung cancer patients after open pulmonary lobectomy. Methods 100 cases of patients with lung cancer undergoing open pulmonary lobectomy were randomly divided into observation and control group with 50 cases in each group. The observation group used ultrasound guided single thoracic paravertebral block（ TPVB） combined with continuous TPVB general anesthesia,while the control group was given nerve stimulator guided thoracic paravertebral nerve block combined with general anesthesia,to compare puncture adverse event incidence,postoperative resting and cough pain score（ VAS） and postoperative complications of the two groups of patients. Results （1）The number of needle path adjustment,the number of times,the average puncture time in the observation group were lower than that of the control group,the difference was statistically significant（ P〈0.05）.（2）The VAS scores during resting and cough state after 12 h,24 h,and 48 h in the observation group were significantly lower than those in control group（ P〈0.05）.（3）The postoperative complication rate of the observation group was 4. 0%,significantly lower than that of the control group（ 10. 0%）（ P〈0.05）. Conclusion Ultrasound guided single TPVB combined with continuous TPVB for lung cancer patients after open pulmonary lobectomy is safety and postoperative pain is light.