超声引导下椎旁阻滞在开胸手术后镇痛的临床应用

Clinical Application of Ultrasound-guided Paravertebral Nerve Block in Analgesia after Thoracotomy

目的探讨超声引导下椎旁神经阻滞在开胸手术术后的镇痛效果.方法 ASAⅠ~Ⅱ级,全身麻醉下行择期开胸手术患者70例,随机分为胸椎旁神经阻滞复合全麻组(T组,n=35)和单纯全身麻醉组(G组,n=35).T组患者于全麻诱导前在超声引导下行开胸侧切口所在胸椎旁间隙注射0.5%罗哌卡因0.25 m L/kg.所有患者术后均使用静脉自控镇痛泵.记录两组患者麻醉前、术后6 h、12 h、24 h、48 h的心率(HR)、平均动脉压(MBP)、吸空气状态下氧饱和度(SpO_2)值及安静及咳嗽时视觉模拟疼痛评分(VAS)和镇痛泵按压总次数、相关并发症,以及术后首次进食时间和首次下床时间.结果与T组比较,G组患者术后6 h、12 h、24 h时的HR、MBP增高,安静及咳嗽时VAS评分明显降低(P<0.05),镇痛泵按压次数明显减少(P<0.05);T组患者术后恶心、呕吐减少,术后首次进食时间及下床时间缩短(P<0.05).结论超声引导下行胸椎旁神经阻滞定位准确,效果确切,用于开胸手术患者可有效减轻术后疼痛,不良反应少,有利于患者早期康复,是目前开胸手术术后镇痛较为理想的一种方法.

Objective To observe the analgesic effect of ultrasound-guided paravertebral nerve block on analgesia after thoracotomy.Methods70patients who were in ASAⅠ～Ⅱand planned to undergo elective thoracotomy surgery with tracheal intubation anesthesia were randomly divided into two groups(Group T and Group G)of35cases each.Patients in group T received paravertebral injection of0.5%of pivocaine under ultrasound guide before induction.Postoperative intravenous self-control analgesia pump was used in all patients.The patients'heart rate(HR)and mean arterial pressure(MAP)and Oxygen saturation air condition(SpO2)were recorded in different moments.The visual analog scale(VAS)scores were recorded at6,12,24and48h after operation.Frequency for compress PCA,related complications,the first eating time and the leaving bed time after operation were recorded as well.Results At6,12and24h after operation,the change in HR,MAP and VAS scale of Group T varied within a smaller range than Group G(P<0.05).The PCA numbers,postoperative nausea and vomiting were significantly less in group P than those in group G(P<0.05).The time of the first eating and the leaving bed after operation was shorten in Group T than in Group G(P<0.05).Conclusion Thoracic paravertebral block by ultrasound guide is accurate and effective for elective thoracotomy patient,can effectively reduce postoperative pain,less adverse reaction,is beneficial to patients with early rehabilitation,is the ideal for postoperative analgesia after thoracotomy.