胸腔镜下胸椎旁阻滞在单孔胸腔镜肺叶切除术镇痛中的应用

Application of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy

目的观察胸腔镜下胸椎旁阻滞在单孔胸腔镜肺叶切除术术后镇痛效果。方法选取2019年12月至2020年4月在宁波市医疗中心李惠利医院行单孔胸腔镜肺叶切除术患者60例,随机数字表法分为对照组(n=30)和椎旁阻滞组(n=30)。椎旁阻滞组在手术结束前在胸腔镜直视下将20 ml、0.375%罗哌卡因注射在胸4~5肋间、椎体旁1 cm处;对照组术后采用静脉自控镇痛。观察两组患者术后6、12、24、36和48 h疼痛视觉模拟评分(VAS)和Ramsay镇静评分,记录两组患者术后不良反应发生率、哌替啶追加剂量和次数,记录两组患者术后恢复进食时间、术后主动咳嗽率、术后首次下床活动时间和术后住院天数。采用t检验和χ^2检验进行统计学分析。结果椎旁阻滞组患者术后各时间点VAS评分均低于对照组,Ramsay镇静评分均高于对照组,差异均有统计学意义(均P<0.05)。椎旁阻滞组患者术后哌替啶追加剂量和次数分别为(8.2±2.3)mg和(0.2±0.1)次,均低于对照组的(87.8±15.3)mg和(1.8±0.3)次,差异均有统计学意义(t=28.91、34.37,均P<0.05)。椎旁阻滞组患者恶心、呕吐和皮肤瘙痒发生率分别为10.0%、6.7%和0,均低于对照组的40.0%、30.0%和13.3%,差异均有统计学意义(χ^2=7.20、5.45、4.29,均P<0.05)。椎旁阻滞组患者主动咳嗽率为33.3%,高于对照组的10.0%,差异有统计学意义(χ^2=4.81,P<0.05)。椎旁阻滞组患者术后恢复进食时间、首次下床活动时间和住院天数分别为(6.5±0.4)h、(20.9±3.1)h和(4.6±1.0)d,均低于对照组的(8.5±0.7)h、(28.6±4.8)h和(6.1±1.3)d,差异均有统计学意义(t=13.47、7.39、4.19,均P<0.05)。结论胸腔镜下胸椎旁阻滞可以有效减轻单孔胸腔镜肺叶切除术患者术后疼痛,不良反应较少,有利于术后恢复。

Objective To investigate the effects of thoracoscopy-guided thoracic paravertebral block for analgesia after single-port video-assisted pulmonary lobectomy.Methods From December 2019 to April 2020,60 patients receiving single-port video-assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected.The patients were randomly and equally divided into control group and paravertebral block group using a random number table.Patients of paravertebral block group were injected into the thoracic 4-5 intercostal,paravertebral 1 cm using 0.375%ropivacaine(20 ml)with thoracoscopy-guided at the end of surgery,while patients of control group were given patient controlled intravenous analgesia(PCIA).Postoperative visual analogue scale(VAS)and Ramsay sedation scale were recorded at 6,12,24,36,48 h after the surgery.The incidence of postoperative adverse reactions,additional dose and times of pethidine,the time to resume eating,the rate of postoperative active cough,the first time to get out of bed after surgery and postoperative hospital stay of two groups′patients were recorded.t test and chisquare test were used for statistical analysis.Results The VAS score of paravertebral block group were lower than those of control group at all time points(all P<0.05).The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points(all P<0.05).The additional dose and times of pethidine of paravertebral block group were(8.2±2.3)mg and(0.2±0.1)time,which were lower than(87.8±15.3)mg and(1.8±0.3)time of control group,the differences were statistically significant(t=28.91,34.37,all P<0.05).Incidence of nausea,vomiting and pruritus of paravertebral block group were 10.0%,6.7%and 0,which were lower than 40.0%,30.0%and 13.3%of control group,the differences were statistically significant(χ^2=7.20,5.45,4.29,all P<0.05).The rate of postoperative active cough of paravertebral block group was 33.3%,which was higher than 10.0%of control group,the difference was statistically significant(χ^2=4.81,P<0.05).The time to resume eating,the first time to get out of bed after surgery and postoperative hospital stay were(6.5±0.4)h,(20.9±3.1)h and(4.6±1.0)d,which were lower than(8.5±0.7)h,(28.6±4.8)h and(6.1±1.3)d of control group,the differences were statistically significant(t=13.47,7.39,4.19,all P<0.05).Conclusion Thoracic paravertebral block under thoracoscopy-guided can effectively reduce the postoperative pain of single-port thoracoscopic lobectomy,with fewer adverse reactions,and is beneficial to postoperative recovery.