改良术中直视下椎旁神经阻滞在胸腔镜肺癌手术中的应用

Application of the modified intraoperative direct paraspinal nerve block in patients received thoracoscopic lung cancer surgery

目的对传统椎旁神经阻滞方案进行改良,并探讨其在胸腔镜肺癌手术患者中的应用效果。方法回顾性分析2015-2017年在解放军南京总医院心胸外科行胸腔镜肺癌手术的患者198例,根据镇痛方案的不同分为MPVB组和PCIA组。MPVB组给予改良椎旁神经阻滞,PCIA组给予病人自控静脉镇痛。比较两组术后镇痛效果及其他临床预后指标。结果 MPVB组共102例,PCIA组共96例。MPVB组操作成功率高(94.1%),术后第6、12、24、48 h的静息/活动VAS评分均明显低于PCIA组(P <0.05),恶心、呕吐等不良反应发生率更低(P <0.05),术后补充使用镇痛药物更少(P <0.05)。同时,MPVB组术后首次下床活动时间和首次肛门排气时间均明显早于PCIA组(P <0.05)。结论改良术中直视下椎旁神经阻滞操作安全、可靠,术后持续镇痛效果稳定且不良反应少,有助于胸腔镜肺癌手术后机体的快速康复。

Objective Wedesigned a new kind of analgesic project improved from previous paravertebral block and aimed to assess its application in patients received thoracoscopic lung cancer surgery.Methods Data of 198 patients underwent thoracoscopic lung cancer surgery from 2015 to 2017 was retrospectively analyzed.Patients were divided into different groups according to the analgesic projects.The patients in MPVB group received the modified paravertebral block,while patients in PCIA group received the intravenous analgesia.The analgesic effect and other clinical prognostic indices between the two groups were compared.Results There were 102 patients in the MPVB group and 96 patients in the PCIA group.An excellent ratio(94.1%)of successful paravertebral block was observed in the MPVB group.The postoperative static or dynamic VAS scores at 6,12,24,48 hours in the MPVB group were all lower than those in the PCIA group(P<0.05,respectively).Moreover,patients in the MPVB group had less adverse reactions(P<0.05),as well as supplementary analgesic drugs usage(P<0.05).In addition,patients in the MPVB group had earlier off-bed activity and exhausting compared with the PCIA group(P<0.05,respectively).Conclusion This modified paravertebral block under intraoperativeview was safe and reliable.This surgery had the prolonged postoperative analgesia and few adverse reactions,which could be beneficial to the enhanced recovery of patients after thoracoscopic lung cancer surgery.