胸腔直视下肋间神经阻滞联合切口局部浸润在胸腔镜术后镇痛的应用

Application of Intercostal Nerve Block under Thoracic Direct Vision Combined with Local Infiltration in Analgesia after Thoracoscopic Surgery

目的:探讨胸腔直视下肋间神经阻滞联合切口局部浸润用于胸腔镜术后镇痛的效果。方法:选择2018年4月至2021年5月在揭阳市人民医院择期行胸腔镜手术患者60例,随机分为M组和V组,每组30例。两组患者均按胸外科快速康复方案进行术前准备,采用标准化支气管插管全身麻醉方案,术后均行静脉镇痛,M组患者在术毕时由外科医生进行直视下肋间神经阻滞联合操作孔局部浸润。记录两组患者苏醒期恢复情况如拔管时间、复苏时间、RSS躁动评分;记录两组患者术后4、8、12、24、48h安静和咳嗽疼痛VAS评分;记录两组患者术后快速康复情况;记录两组患者补救性镇痛情况;记录两组患者术后不良反应发生情况。结果:M组患者RSS躁动评分明显低于V组(P<0.05),M组患者术后4、8、12、24h安静和咳嗽疼痛VAS评分明显低于V组(P<0.05),M组患者首次下床活动时间、首次肛门排气时间、首次进固体食物时间明显低于V组(P<0.05),术后48h内下床活动总次数明显高于V组(P<0.05),M组患者氟比洛芬酯、舒芬太尼补救性镇痛例数明显低于V组(P<0.05),两组患者术后均未发生嗜睡、恶心呕吐等不良反应。结论:术毕胸腔直视下肋间神经阻滞联合切口局部浸润能为胸腔镜手术提供良好术后镇痛,减少阿片类药物应用,促进患者快速康复。

Objective:To investigate the analgesic effect of intercostal nerve block under thoracic direct vision combined with local infiltration after thoracoscopic surgery.Methods:60 patients who underwent thoracoscopy from April 2018 to may 2021 were randomly divided into group M and group V,30 cases in each group.The patients in the two groups were prepared according to the fast rehabilitation plan of thoracic surgery before operation,and the standardized general anesthesia plan of bronchial intubation was used.The patients in the group M were treated with intercostal nerve block under direct vision combined with local infiltration of operation hole by the surgeon at the end of operation.The recovery of patients in the recovery period,such as extubation time,recovery time,RSS restlessness score,were recorded.VAS scores of quiet and cough pain were recorded at 4,8,12,24 and 48 hours after operation.The fast recovery of the two groups were recorded.The remedial analgesia of the two groups was recorded.The incidence of postoperative adverse reactions was recorded.Results:The RSS agitation score of group M was significantly lower than that of group V(P<0.05).The VAS scores of quiet and cough pain in group M were significantly lower than those in group V at 4,8,12 and 24 hours after operation(P<0.05).The time of first ambulation,first anal exhaust and first solid food intake of group M were significantly lower than those of group V(P<0.05).The total number of ambulation within 48 hours after operation was significantly higher than that of group V(P<0.05),The number of patients in group M with rescue analgesia of flurbiprofen axetil and sufentanil was significantly lower than that in group V(P<0.05).Conclusion:Intercostal nerve block under thoracic direct vision combined with local infiltration of incision after thoracoscopic surgery can provide good postoperative analgesia,reduce the use of opioids,and promote the rapid recovery of patients.