针刺复合椎旁阻滞对剖胸手术患者围术期疼痛的影响  

EFFECTS OF ACUPUNCTURE COMBINED WITH ULTRASOUND-GUIDED PARAVERTEBRAL BLOCK ON PERIOPERATIVE ANALGESIA IN PATIENTS UNDERGOING THORACOTOMY SURGERY

作　　者：於章杰[1] 殷文渊[1] 宋建钢[1] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127

出　　处：《中国疼痛医学杂志》2013年第2期71-74,共4页Chinese Journal of Pain Medicine

基　　金：国家重大基础研究计划(973)资助项目(2013CB531902)

摘　　要：目的:观察针刺复合椎旁神经阻滞对剖胸手术患者围术期镇痛效果是否优于单纯锥旁阻滞。方法:选择单侧肺叶切除术患者40例,随机分为针刺复合椎旁阻滞组(A+PVB)、单纯椎旁阻滞组(PVB)各20例。A+PVB组患者在麻醉前接受相关穴位的连续电针刺激,并在超声引导下行切口水平上下截段的单次椎旁神经阻滞;PVB组患者仅在麻醉前接受单次椎旁神经阻滞,同时两组术后行自控镇痛。选择术中及术后镇痛药物用量、术后视觉模拟评分(visual analogue scale,VAS)、术中血管活性药物用量、神经阻滞消退时间、术后恶心呕吐(postoperative nausea and vomiting,PONV)发生率、术后拔管时间、呼吸系统并发症发生率等作为观察指标,统计两组各参数差异。结果:A+PVB组术中瑞芬太尼用量显著显著少于PVB组(P<0.01);A+PVB组术后自控镇痛的舒芬太尼用量显著少于PVB组(P<0.01);A+PVB组术后12 h、24 h、36 h的静息VAS评分显著少于PVB组(P<0.05),A+PVB组术后12 h、36 h的运动疼痛VAS评分显著少于PVB组(P<0.05);A+PVB组术中苯肾上腺素用量显著少于PVB组(P<0.05);A+PVB组术后拔管时间显著少于PVB组(P<0.05);两组术后PONV发生率、ICU时间、住院时间和呼吸系统并发症发生率差异无统计学意义。结论:针刺复合椎旁阻滞较单纯椎旁阻滞可减少术中及术后镇痛药物用量,术中循环干扰小,并加快术后拔管时间。Objective： To investigate the influence of acupuncture combined paravertebral block on perioperative analgesic effect in thoracotomy patients. Methods： Forty patients undergoing unilateral lobectomy were recruited and randomly devided equally into 2 groups. Group A＋PVB received continued electroacupuncture at relevant acupoints and thoracic paravertebral block guided by ultrasound above and below the level of incision. Group PVB simply received paravertebral block. Both groups received patient- controlled analgesia postoperatively. Total dosage of perioperative analgesics, visual analogue scale （VAS） scores after surgery, dosage of hymodynamic agents, dissipation time of nerve block, incidence of post- operative nausea and vomiting （PONV）, time for extubation and incidences of respiratory complication were observed and compared in both groups. Results： The intraoperative dosage of remifentanyl, the dosage of sufentanyl consumption in PCIA in Group A＋PVB was significantly less than Group PVB （P 〈 0.01 respectively）. The static VAS scores on 12 h, 24 h, 36 h and the dynamic VAS scores on 12 h, 35 h after surgery in Group A＋PVB were significantly less than that in Group PVB （P 〈 0.05, respectively）; the dosage of phenylephrine and time for extubation in Group A＋PVB were significantly less than that in Group PVB （P 〈 0.05 respectively）. The difference of incidence of PONV, ICU stay, LOS and incidence of respiratory complication between two groups had no statistical significance. Conclusion： Acupuncture combined with ultrasound-guided paravertebral block could reduce perioperative analgesics consumption, provide more stable hymodynamic state and less time for extubation, when compared with paravertebral block alone.

关 键 词：针刺 超声引导椎旁阻滞 剖胸手术 镇痛 

分 类 号：R614[医药卫生—麻醉学]