肋间神经阻滞与胸椎旁神经阻滞在胸腔镜手术中的应用效果

Application effect of intercostal nerve block and thoracic paravertebral nerve block in thoracoscopic surgery

目的探讨肋间神经阻滞与胸椎旁神经阻滞在胸腔镜手术中的应用效果。方法选取2015年8月至2017年8月本院收治的行胸腔镜下手术治疗的肺大泡患者110例,按照随机数字表法分为观察组和对照组,每组55例。所有患者均在局部神经阻滞联合静吸复合麻醉下实施手术。术后镇痛中,观察组实施胸椎旁神经阻滞,对照组实施肋间神经阻滞,对所有患者进行床旁随访48 h。比较两组患者术后6、12、24、48 h的疼痛评分和Ramsay镇静评分;比较两组随访期间自控镇痛按压次数;比较两组患者术后48 h生活质量与睡眠质量。结果术后6、12、24、48 h,观察组患者VAS疼痛评分均显著低于同期对照组,Ramsay镇静评分均显著高于同期对照组,差异具有统计学意义(P<0.05);术后48 h内,观察组自控镇痛泵按压次数显著少于对照组,差异具有统计学意义(P<0.05);术后48 h,观察组患者生活质量评分和睡眠质量评分均显著优于对照组,差异具有统计学意义(P<0.05)。结论相较于肋间神经阻滞镇痛,胸椎旁神经阻滞应用于胸腔镜术后,其镇痛效果更为理想,能显著提高患者的生活质量和睡眠质量,值得临床推广应用。

Objective To investigate the application effect of intercostal nerve block and thoracic paravertebral nerveblock in thoracoscopic surgery. Methods From August 2015 to August 2017, 110 patients with bullae who underwentthoracoscopic surgery in our hospital were divided into observation group and control group according to random numbertable method, with 55 cases in each group. All patients were operated under local nerve block combined with intravenousinhalation anesthesia. In the postoperative analgesia method, the observation group was given thoracic paravertebral nerveblock, and the control group was given intercostal nerve block. All patients were followed up for 48 h. The pain scores andRamsay sedative scores at 6, 12, 24, 48 h after surgery were compared between the two groups, the numbers of controlledanalgesia pumps during follow-up of both groups were compared; the quality of life and sleep quality at 48 h after surgerywere compared between the two groups. Results At 6, 12, 24, 48h after operation, the VAS pain scores of the observationgroup were significantly lower than those of the control group, and the Ramsay sedation scores of the observation groupwere significantly higher than those of the control group（P〈0.05）. At 48 h after operation, the times of controlled analgesiapumps in the observation group was less than that in the control group, and the difference was statistically significant （P〈0.05）. At 48h after operation, the life quality score and the sleep quality score in the observation group were significantlybetter than those of the control group （P〈0.05）. Conclusion Compared with intercostal nerve block analgesia, thoracicparavertebral nerve block has better analgesic effect after thoracoscopic surgery, which can significantly improve the qualityof life and sleep of patients. It is worthy of clinical popularization and application.