胸椎旁神经阻滞对开胸手术患者静脉镇痛效果的影响  

Effect of thoracic paravertebral blockade on postoperative analgesia in patients undergoing thoracic surgery

作　　者：徐益萍[1] 吴东进[1] 吴蔚宇[1] 徐美英[1] 

机构地区：[1]上海交通大学医学院附属胸科医院麻醉科,200030

出　　处：《临床麻醉学杂志》2009年第2期133-135,共3页Journal of Clinical Anesthesiology

基　　金：上海市科委科研计划项目课题(编号:054119559)

摘　　要：目的研究胸椎旁神经阻滞对开胸手术后静脉镇痛效果的影响。方法择期全麻下肺叶切除术的患者102例,随机分成三组:Ⅰ组,32例,单纯全麻;Ⅱ组,36例,于全麻诱导后行胸椎旁神经阻滞;Ⅲ组,34例,于全麻诱导前行硬膜外阻滞。三组均于术毕缝皮时启动患者静脉自控镇痛(PCIA)泵行芬太尼、氟比洛芬酯静脉镇痛,分别于患者清醒拔除气管导管后即刻(T1)、术后24h(T2)、48h(T3)进行视觉模拟评分(VAS),记录启动自控按钮次数及背景输注总量。结果三组24、48hPCIA泵的背景输注总量差异无统计学意义。Ⅱ、Ⅲ组在T1、T2时的VAS均低于Ⅰ组(P<0.05),术后48h内启动自控按钮次数明显少于Ⅰ组(P<0.05)。结论在开胸手术前行胸椎旁神经阻滞或硬膜外阻滞可以增强芬太尼、氟比洛芬酯的静脉镇痛效果。Objective To observe the effect of thoracic paravertebral block on postoperative analgesia in patients undergoing thoracic surgery, Methods One hundred and two patients undergoing lung resection were ramdomly allocated into three groups. The patients in group I （n= 32） were given general anesthesia. The thoracic paravertebral blockade was performed after induction in patients of group Ⅱ （n=36）. General anesthesia combined with epidural block was performed in patients of group Ⅲ （n=34）. PCIA pump started before the end of surgery in 3 groups. VAS score was recorded at extubation （T1） and 24 h（T2）,48 h（T3） after surgery and the times of PCIA and the volume of analgesic drugs used were recorded during 48 h after surgery. Results There was no significant difference in analgesic volume used during 48 h analgesia. VAS scores at T1 and T2 and PCIA times during ananlgesia were lower in groups Ⅱ and Ⅲ than those in group I （P〈0.05）. Conclusion Thoracic paravertebral blockade or epidural block can augment the analgesic effect of PCIA with fentanly and flurbiprofen axetil in patient undergoing thoracic surgery.

关 键 词：术后镇痛 胸椎旁神经阻滞 患者 手术治疗 

分 类 号：R614[医药卫生—麻醉学]