肋间神经阻滞超前镇痛在胸腔镜肺大泡切除手术中的临床观察

Clinical observation of preemptive analgesia with intercostal nerve block in thoracoscopic pulmonary bullous resection

目的探讨肋间神经阻滞超前镇痛在胸腔镜肺大泡切除手术中的应用效果,以提高对胸腔镜术后患者的临床疗效。方法我科在2016年6月～2017年12月对80例胸腔镜肺大泡手术的患者行肋间神经阻滞超前镇痛胸腔镜肺大泡切除手术,按随机数字表法分成两组,每组40例,观察组于麻醉成功后手术前行肋间神经阻滞,部位为操作切口和闭式引流切口所在肋间及其上下各1个肋间的椎旁行肋间神经阻滞术,两组均实行术后镇痛。观察两组患者术后苏醒时间、全麻苏醒期间谵妄发生率、术后镇痛效果及患者的满意度情况。结果与对照组比较,观察组睁眼时间、呼吸恢复时间、拨管时间及谵妄的发生率明显少于对照组(P<0.05),在术后各时段的VAS评分明显降低(P<0.05),观察组病人满意度明显升高(P<0.05)。观察组恶心呕吐、皮肤瘙痒、尿潴留的发生率与对照组比较无统计学差异(P>0.05)。结论肋间神经阻滞超前疼痛在胸腔镜肺大泡切除手术中可以缩短患者的麻醉苏醒时间,降低全麻苏醒期谵妄的发生率,术后镇痛效果优良,病人满意度高,术后并发症少。

Objective To investigate the application effect of preemptive analgesia of intercostal nerve block in thoracoscopic pulmonary bullae resection and to improve the clinical efficacy of patients after thoracoscopic surgery. Methods 80 patients with thoracoscopic pulmonary alveolar surgery who underwent preemptive analgesia of intercostal nerve block angioplasty for thoracoscopic pulmonary bullous resection from June 2016 to December 2017 were randomly divided into two groups according to the random number table, with 40 cases in each group. The observation group underwent preoperative intercostal nerve block after the operation of the anesthesia. The intercostal nerve block was performed at the intervertebral space between the ribs and the upper and lower ribs of the operation incision and closed drainage incision. The postoperative analgesia was performed in both groups. The postoperative recovery time, delirium occurrence rate during general anesthesia recovery, postoperative analgesia effect and patient satisfaction were observed in the two groups. Results Compared with the control group, the eye opening time, breathing recovery time, extraction time and the incidence of delirium was significantly lower in the observation group than that in the control group(P<0.05). And the VAS score was significantly lower at each time after surgery(P<0.05). Patient satisfaction in the observation group increased significantly(P<0.05). There was no significant difference in the incidence of nausea and vomiting, itchy skin, and urinary retention in the observation group compared with that in control group(P>0.05). Conclusion The preemptive analgesia with intercostal nerve block in thoracoscopic pulmonary bullous resection can shorten the anesthesia recovery time and reduce delirium occurrence rate during anesthesia recovery period. The postoperative analgesic effect is excellent, and the patient satisfaction is high, and postoperative complications are fewer.