肋间神经阻滞对胸部手术患者术后镇痛效果和通气功能的影响

The Prevent Effectiveness of Intraoperative Intercostal Nerve Blockade on Postthoracotomy Pain

目的 :探讨开胸手术中肋间神经阻滞对术后的镇痛效果。方法 :30例择期开胸手术患者随机等分为静脉镇痛组 (A组 )及肋间神经阻滞合并静脉镇痛组 (II组 )。A组术后持续以 2 .5ml/h静脉泵入芬太尼 (15 μg/ml) +咪唑安定 (0 .3mg/ml) ;B组关胸前 0 .5 %布比卡因行切口及上下肋间神经阻滞 ,术后静脉 2 .5ml/h持续输注泵入芬太尼 (10 μg/ml) +咪唑安定 (0 .3mg/ml)。患者术后以视觉模拟评分法行痛觉评分 (VAS) ;测量HR、MAP、PaO2 及PaCO2 ;测定用力肺活量 (FVC)和第一秒用力呼出气量 (FEV1)。结果 :A组术后 3、6hVAS评分明显高于B组 (P<0 .0 5 ) ;B组术后 3、6hFVC及FEV1显著高于A组 (P <0 .0 1,0 .0 5 ) ;A组患者入监护室后即刻 (0h)PaO2 明显低于B组 (P <0 .0 5 )。结论

Objective: To evaluate the prevent effectiveness of intraoperative intercostal nerve blockade on postthoracotomy pain.Methods:Thirty patients undergoing elective thoracotomy were randomly divided into two groups:intravenous infusion of fentanyl(15 μg/ml)at a rate of 2.5 ml/h after operation(group A, n =15);intraoperative intercostal nerve blockade using 0.5% bupivacaine plus postoperative intravenous infusion of fentanyl(10 μg/ml)(group B, n =15).The pain scores as visual analogue scale (VAS),forced vital capacity(FVC),forced expired volume in the first second of exhalation(FEV1),PaO 2,PaCO 2,heart rate and blood pressure were assessed at 0(immediately after arrival in ICU),3, 6, 12, 24,and 48 postoperative hours.Results:The VAS scores in group A were significantly higher than that of group B at 3,6 postoperative hours( P <0.05).The FVC and FEV1 of group B were significantly higher than that of group A.Conclusion:Above results indicate that intraoperative intercostal nerve blockade might improve analgesic efficacy of intravenous fentanyl for postthoracotomy pain,especially early after operation.