经胸膜穿刺置管持续椎旁阻滞用于剖胸术后镇痛的临床研究

CLINICAL STUDY ON CONTINUOUS PARAVERTEBRAL BLOCK VIA PARACENTESIS OF EXTRAPLEURAL CATHETERICATION FOR POSTTHORACOTOMY ANALGESIA

目的 :观察经胸膜穿刺置管持续椎旁阻滞用于单侧剖胸术后镇痛效果和对血流动力学的影响。方法 :60例单侧剖胸术病人根据术后镇痛方法随机平分 3组 :椎旁阻滞 (PVB)组 ,是在术中经壁层胸膜穿刺置一根硬膜外导管于椎旁间隙 ;硬膜外阻滞 (Ep)组 ;PVB0 组是PVB的空白对照。术后病人出现切口中度疼痛时用0 .2 %布比卡因镇痛 ,负荷量 10～ 15ml,持续量 2～ 4ml/hr。观察镇痛前后的疼痛评分、呼吸功能及血压 (SBP ,DBP) ,心率 (HR)和SpO2 变化。结果 :PVB和Ep组镇痛后与镇痛前相比 ,VAS及PrinceHenry疼痛评分降低P <0 .0 1,呼吸通气功能FVC ,FEV1.0改善P <0 .0 1;PVB ,Ep组与PVB0 组相比 ,疼痛评分较低 ,FVC ,FEV1.0较高 ,组间变化P <0 .0 1;各组内SBP ,DBP ,HR和SpO2 均无明显变化P >0 .0 5。结论 :经胸膜穿刺置管行椎旁阻滞操作简单安全、镇痛完善 ,无并发症及毒副作用 。

Objective: To observe the analgesic effects of continuous paravertebral block via paracentesis of extrapleural catheterication and its effects on hemodynamics after unilateral thoracotomy.Methods:Sixty patients undergoing unilateral thoracotomy were randomized equally into 3 groups by the analgesic methods: the paravertebral block group (Group PVB) with a catheter inserted via parietal pleura into paravertebral space during the thoracotomy,the epidural block group (Group Ep), and the Group PVB0 which was the blank test of PVB.When the patients experienced moderate pain after thoracotomy, 0.2%Bubivacaine 10～15 ml initially and followed by 2～4 ml/hr were used for analgesia. The changes of the scale of pain , pulmonary function ,blood pressure (SBP, DBP),heart rates (HR) and SpO 2 were observed before and after analgesia. Results: After analgesia, Visual Analogue Scale (VAS) and Prince Henry score in Group PVB and Ep were significantly low (P<0.01), with FVC and FEV1.0 markedly improved (P<0.01) compared with those before. In comparison with Group PVB0 ,the score in Group PVB and Ep were significantly low (P<0.01),and FVC and FEV1. 0 in them markedly improved (P< 0.01). There were no significant changes in SBP, DBP, HR and SpO 2 within each individual groups (P> 0.05).Conclusions: Continuous paravertebral block via paracentesis of extrapleural catheterication is operatively simple and safe with perfect analgesia and without side effects and complications related to the cathetered paracentesis,and it is suitabl for pain relief after unilateral thoracotomy.