超声引导下椎旁神经阻滞在老年患者胃癌根治术中的应用效果

Application effect of ultrasound guided paravertebral nerve block in elderly patients undergoing radical gastrectomy for gastric cancer

目的研究超声引导下双侧椎旁神经阻滞在老年患者胃癌根治术的应用效果。方法将66例胃癌根治术老年患者随机分为超声引导下椎旁神经阻滞组(PVB组,P组)与对照组(Control组,C组),各33例。P组在超声引导下双侧T6、T7、T8三个阶段椎旁各注射0.15%罗哌卡因5 mL;C组在气管插管后不进行超声引导的神经阻滞。比较两组镇痛效果。结果P组术后1、6、12、24 h的VAS评分均低于C组(P<0.05)。P组24 h使用镇痛药物的患者例数及镇痛泵按压总次数明显少于C组,恶心、呕吐发生率低于C组(P<0.05)。P组非常满意率高于C组,患者肠道排气时间和第一次下床时间均短于C组(P<0.05)。结论超声引导下应用0.15%罗哌卡因进行双侧椎旁神经阻滞术后镇痛确切、并发症少、患者满意度高。

Objective To study the application effect of ultrasound guided bilateral paravertebral nerve block in elderly patients undergoing radical gastrectomy for gastric cancer.Methods Sixty-six elderly patients undergoing radical gastrectomy for gastric cancer were divided into paravertebral nerve block group(P group)and control group(C group),with 33 cases in each group.In the group P,5 mL of 0.15%ropivacaine was injected in each side of the paravertebral at three stages of T6,T7 and T8 under the guidance of ultrasound respectively;in the group C,nerve block under the guidance of ultrasound was not performed after tracheal intubation.The analgesic effects of the two groups were compared.Results The VAS scores at 1,6,12,24 h of the group P were lower than those of the group C(P<0.05).In the group P,the number of patients who used analgesics within 24 h and the total number of times of compression of analgesics pump were significantly less than those in the group C,and the incidences of nausea and vomiting were lower than those in the group C(P<0.05).The satisfactory rate of the group P was higher than of the group C,the time of bowel exhaust and the first time of getting out of bed were shorter than those of the group C(P<0.05).Conclusion Ultrasound guided application of 0.15%ropivacaine for bilateral paravertebral nerve block is accurate,with less complications and higher patient satisfaction.