椎旁神经阻滞对开胸术患者超前镇痛的作用分析

Function analysis of paravertebral nerve block for preemptive analgesia on patients with thoracic surgery

目的探讨椎旁神经阻滞用于开胸术患者超前镇痛的作用效果,为临床麻醉提供参考。方法选取2014年3月至2016年2月在我院接受开胸术的102例患者为观察对象,根据麻醉方法分为观察组及对照组,每组51例。所有患者均进行全凭静脉麻醉,对照组注入异丙酚1~2 mg/kg、舒芬太尼0.4~0.5μg/kg、咪达唑仑0.1 mg/kg以及罗库溴铵0.5~0.7 mg/kg,观察组在对照组的基础上利用超声引导进行椎旁神经阻滞,注入5 mL浓度为0.5%的罗哌卡因、舒芬太尼0.1~0.3μg·kg^(-1)·min^(-1)与异丙酚6~8 mg·kg^(-1)·min^(-1),对比2组效果。结果观察组在手术过程中全身麻醉维持异丙酚、瑞芬太尼以及罗库溴铵用量均显著低于对照组。观察组不同时间段VAS评分、术后肺部并发症发生率、入住ICU率、气管拔管时间、术后恢复时间均显著低于对照组,而气管拔管后30 min时SpO_2高于对照组,差异具有统计学意义(P<0.05)。结论椎旁神经阻滞用于开胸术患者不仅麻醉用药量更少,而且具有超前的镇痛效果,从而可高效促进患者恢复。

Objective To explore the effect of paravertebral nerve block for preemptive analgesia on patients with thoracic surgery, and provide reference for clinical anesthesia. Methods From March 2014 to February 2016,102 patients with thoracic surgery in our hospital were selected as the research object, and they were divided into the observation group and the control group with 51 cases in each group ac- cording to the anesthesia methods. All the patients were given total intravenous anesthesia. Patients of the control group were injected propofol 1 - 2 mg/kg, sufentanil 0. 4 - 0.5 g/kg, midazolam 0. 1 mg/kg and rocuronium 0.5 - 0. 7 mg/kg, while patients of the observation group were injected ropivaeaine （with concentration of 0. 5% ）5 mL, sufentanil 0.1 -0.3 μg·kg^-1·min^-1 and propofol 6 - 8 mg·kg^-1·min^-1 as an addition with the use of ultrasound to guide the paravertebral nerve block. The effect of the two groups were compared. Results The dosage of propofol, remifentanil and rocuronium in the observation group were significantly lower than those in the control group during the operation. The VAS score, postoperative pulmonary complication rate, ICU rate, extubation time, postoperative recovery time at different time of observa- tion group were significantly lower than those of the control group, and SpO2 was higher in control group 30 minutes after tracheal extubation, the differences were significant （ P 〈 0. 05 ）. Conclusion Paravertebral nerve block requires less dosage of anaesthetic, and it has more sig- nificant analgesia effect on patients with thoracic surgery, which can efficiently promote the recovery of patients.