超声引导下胸椎旁神经阻滞对气管内插管全麻肺挫裂伤修补患者术后镇痛效果的影响

Effect of ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with pulmonary contusion and laceration repaired by endotracheal intubation under general anesthesia

目的探讨超声引导下胸椎旁神经阻滞对气管内插管全麻肺挫裂伤修补患者术后镇痛效果的影响。方法选取2020年8月至2020年12月于本院行气管内插管全麻手术的60例肺挫裂伤修补患者作为研究对象,随机分为全麻组与复合组,每组30例。全麻组给予气管内插管全麻诱导,复合组在麻醉诱导前行超声引导下胸椎旁神经阻滞。比较两组术后不同时间点VAS评分、炎症因子水平[白介素(IL)-6、肿瘤坏死因子(TNF)-α]和PCIA使用情况。结果术后2、24及48 h,复合组VAS评分均低于全麻组,差异有统计学意义(P<0.05)。术后2、24及48 h,复合组IL-6水平均低于全麻组,TNF-α水平均高于全麻组,差异有统计学意义(P<0.05)。复合组术后24 h舒芬太尼用量、PCIA泵按压次数和背景输注总量均少于全麻组,差异有统计学意义(P<0.05)。结论超声引导下胸椎旁神经阻滞用于气管内插管全麻肺挫裂伤修补的麻醉及镇痛效果显著,值得临床推广应用。

Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with pulmonary contusion and laceration repaired by endotracheal intubation under general anesthesia. Methods 60 patients who underwent endotracheal intubation and general anesthesia in our hospital from August 2020 to December 2020 were selected as the research subjects. They were randomly divided into general anesthesia group and composite group, with 30 cases in each group. The general anesthesia group was given endotracheal intubation for general anesthesia induction, and the composite group received ultrasound-guided thoracic paravertebral nerve block before anesthesia induction. The VAS score, inflammatory factor levels(interleukin [IL]-6, tumor necrosis factor [TNF]-α) and PCIA usage at different time points between the two groups were compared. Results At 2, 24, and 48 h after operation, the VAS scores of the composite group were lower than those of the general anesthesia group, and the difference was statistically significant(P<0.05). At 2, 24, and 48 h after operation, the levels of IL-6 in the composite group were lower than those in the general anesthesia group, and the levels of TNF-α was higher than that in the general anesthesia group,and the difference was statistically significant(P<0.05). The amount of sufentanil, the number of PCIA pump compressions and the total amount of background infusion at 24 h after the operation in the composite group were less than those in the general anesthesia group, and the difference was statistically significant(P<0.05). Conclusion Ultrasound-guided thoracic paravertebral nerve block used in endotracheal intubation general anesthesia for lung contusion and laceration repair has significant anesthesia and analgesia effects, and it is worthy of clinical application.