超声引导胸椎旁阻滞治疗胸腔镜手术后患者中重度疼痛的安全性分析

Safety analysis of ultrasound-guided thoracic paravertebral block in the treatment of moderate to severe pain in patients after thoracoscopic surgery

目的探讨胸腔镜手术后中重度疼痛患者实施胸椎旁神经阻滞(TPVB)治疗的临床效果。方法选取2020年4月至2022年4月新余市人民医院收治的72例胸腔镜术后中重度疼痛患者作为研究对象,采用入院号机械抽样随机法将其分为对照组与观察组(各组36例)。对照组采用舒芬太尼治疗,观察组采用超声引导TPVB治疗。比较两组的疼痛评分、术后生命体征、舒芬太尼用量和麻醉苏醒期停留时间、疼痛和炎症因子水平、不良反应发生率。结果观察组术后1、8、24、48 h的静息状态、活动状态下视觉模拟评分法(VAS)评分低于对照组,差异有统计学意义(P<0.05);观察组术后1 h的血氧饱和度高于对照组,收缩压、舒张压低于对照组,差异有统计学意义(P<0.05),观察组与对照组术后1 h的心率比较,差异无统计学意义(P>0.05);观察组的舒芬太尼用量低于对照组,差异有统计学意义(P<0.05),观察组与对照组的麻醉苏醒室停留时间比较,差异无统计学意义(P>0.05);观察组术后48 h的白细胞介素、前列腺素水平低于对照组,差异有统计学意义(P<0.05);观察组与对照组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论在胸腔镜手术后中重度疼痛患者实施TPVB治疗,可显著缓解患者术后急性疼痛,且减少阿片类药物的使用量,平稳度过疼痛期。

Objective To explore the clinical effect of thoracic paravertebral nerve block(TPVB)treatment on patients with moderate to severe pain after thoracoscopic surgery.Methods A total of 72 patients with moderate to severe pain after thoracoscopic surgery at Xinyu City People's Hospital from April 2020 to April 2022 were selected as the study subjects.They were divided into control group and observation group(36 cases in each group)using the mechanical sampling method of admission number.The control group received sufentanil treatment,while the observation group received ultrasound guided TPVB treatment.The pain scores,postoperative vital signs,dosage of sufentanil,duration of anesthesia recovery,levels of pain and inflammatory factors,and incidence of adverse reactions were compared between the two groups.Results The visual analogue scale(VAS)score of the observation group at 1 hour,8 hours,24 hours,and 48 hours after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The blood oxygen saturation at 1 hour after surgery in the observation group was higher than that in the control group,while the systolic and diastolic blood pressure were lower than those in the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in heart rate between the observation group and the control group at 1 hour after surgery(P>0.05).The dosage of sufentanil in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).However,there was no statistically significant difference in the stay time in the anesthesia recovery room between the observation group and the control group(P>0.05).The levels of interlenkin 6 and prostaglandin E2 in the observation group at 48 hours after surgery were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group(P>0.05).Conclusion Implementing TPVB treatment in patients with moderate to severe pain after thoracoscopic surgery can significantly alleviate acute postoperative pain,reduce the use of opioids,and smoothly pass the pain period.