超声引导下胸椎旁神经阻滞在上段输尿管结石切开取石术中的应用

Application of Ultrasound-guided Paravertebral Nerve Block in the Upper Ureteral Stone Incision and Removal

目的超声引导下胸椎旁神经阻滞应用于上段输尿管结石切开取石术的镇痛效果。方法选择2017年5月~2019年5月于我院择期行输尿管结石切开取石术患者60例,将其随机分为对照组和观察组,各30例,对照组患者行硬膜外阻滞组,观察组行椎旁神经阻滞,操作完成后分别行全身麻醉,术毕连接同一镇痛配方的静脉自控镇痛泵。比较两组静息5 min后(M_(0))、麻醉穿刺操作时(M_(1))、穿刺操作后15 min(M_(2))、手术开始时(M_(3))、手术进行30 min(M_(4))、手术结束拔管后10 min(M_(5))平均动脉压(MAP)、心率(HR)、VAS评分及围术期不良反应发生情况。结果M_(0),M_(1)时,两组MAP、HR比较,差异无统计学意义(P>0.05);M_(2)时观察组MAP高于对照组,HR低于对照组,差异有统计学意义(P<0.05);M_(3)、M_(4)时,观察组MAP、HR低于对照组,差异有统计学意义(P<0.05);术后2、4、8、12、24 h,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);两组围术期不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导椎旁神经阻滞可以满足上段输尿管结石切开取石术的镇痛要求,患者围术期血流动力学更稳定,麻醉效果更好,操作安全性高,不良反应少,值得临床应用。

Objective The analgesic effect of ultrasound-guided thoracic paravertebral nerve block applied to upper ureteral stone incision and removal.Methods 60 patients who underwent elective ureteral calculi incision and stone removal in our hospital from May 2017 to May 2019 were randomly divided into control group and observation group,30 cases in each group.Patients in the control group underwent epidural block and the observation group underwent paravertebral nerve block.After the operation was completed,they underwent general anesthesia,and connected to the intravenous self-control analgesic pump of the same analgesic formula after the operation.Compare the two groups after resting for 5 min(M_(0)),during anesthesia puncture operation(M_(1)),15 min after puncture operation(M_(2)),at the beginning of surgery(M_(3)),surgery performed 30 min(M_(4)),10 min after extubation(M_(5)),mean arterial pressure(MAP),heart rate(HR),VAS score,and perioperative adverse reactions occurred 10 min after the operation was completed.Results There was no significant difference in MAP and HR between the two groups at M_(0) and M_(1)(P>0.05);At M_(2),the MAP of the observation group was higher than that of the control group.HR was lower than the control group,the difference was statistically significant(P<0.05);At M_(3) and M_(4),the MAP and HR of the observation group were lower than those of the control group,the difference was statistically significant(P<0.05);At 2,4,8,12,and 24 h after operation,the VAS scores of the observation group were lower than those of the control group,the difference was statistically significant(P<0.05);There was no significant difference in the incidence of perioperative adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided paravertebral nerve block can meet the analgesic requirements of upper ureteral calculi incision and removal.The patient's perioperative hemodynamics is more stable,the anesthesia effect is better,the operation safety is high,and the adverse reactions are less.It is worthy of clinical application.