椎旁神经阻滞复合静脉自控镇痛在开胸手术术后镇痛中的应用

目的探讨椎旁神经阻滞复合静脉自控镇痛在开胸手术术后镇痛应用中的安全性和有效性.方法选取2015年4月至2017年10月择期行开胸手术的患者68例,按照随机数字表法将患者分为观察组和对照组,每组各34例,观察组为超声引导下连续椎旁神经阻滞复合全身麻醉,术后单次椎旁神经阻滞镇痛+静脉自控镇痛,对照组为单纯全身麻醉,术后静脉自控镇痛(PCIA).观察并记录患者术中使用芬太尼的剂量、术后患者镇痛泵按压次数及术后不良反应发生情况;术后2h、6h、12h、24h、48h患者安静及咳嗽时的视觉模拟评分.结果观察组患者术中使用芬太尼剂量明显少于对照组,组间差异有统计学意义(P<0.05),术后镇痛泵按压次数及恶心呕吐、出汗、眩晕等不良反应发生率显著低于对照组,组间差异有统计学意义(P<0.05);患者术后12h内安静时的VAS评分显著低于对照组,术后24h内咳嗽时的VAS评分显著低于对照组,组间差异有统计学意义(P<0.05).结论椎旁神经阻滞复合静脉自控镇痛可显著降低开胸手术患者术后短期内的VAS疼痛评分,减少患者术后镇痛药物的摄入量,有效避免不良反应的发生率,具有较好的临床安全性和有效性.

Objective To investigate the safety and efficacy of thoracic paravertebral never block combined with patient-controlled intravenous analgesia(PCIA) on postoperative analgesia after thoracic surgery. Methods 68 cases of patients who underwent thoracotomy in Shao Xing Central Hospital from April 2015 to October 2017 were selected as the study objects and they were randomly divided into observation group and control group, with 34 case in each group. The observation group was treated with ultrasound-guided continuous paravertebral nerve block combined with general anesthesia,68 cases of patients who underwent thoracotomy in the hospital from April 2015 to October 2017 were selected as the study objects and they were randomly divided into observation group and control group,with 34 case in each group. The observation group was treated with ultrasound-guided continuous paraspinal nerve block combined with general anesthesia,postoperative single paravertebral nerve block and PICA,the control group was treated with simple general anesthesia and PCIA. The doses of fentanyl used in the operation,the number of postoperative analgesic pump presses and the adverse reaction after operation were observed and recorded. The visual analog scale(VAS) at 2h,6h,12h,24h and 48h after operation were recorded. Results The dosage of fentanyl in observation group was significantly lower than in control group,the differences were statistically significant(P<0.05),the times of postoperative analgesic pump presses and the adverse reactions such as nausea,vomiting,sweating,and dizziness in observation group were significantly lower than in control group,the difference between two groups was significant (P<0.05). The VAS score at rest was significantly lower than the control group at first 12 hours postoperatively.,The VAS score in cough was significantly lower than the control group at first 24 hours postoperatively,the differences between groups were statistically significant(P<0.05). Conclusion Thoracic paravertebral never block combined with PCIA can significantly decrease the VAS score in thoracotomy patient. It can reduce the postoperative analgesic drug intake,avoid the incidence of adverse reactions. It has good safety and efficacy in clinical practice.