单点或多点胸椎旁神经阻滞在胸腔镜肺叶切除患者术后镇痛的临床研究  

Investigation on thoracic paravertebral block by single injection or multiple injections in patients with video-assisted thoracoscopic lung lobe surgery

作　　者：章蔚[1] 李娟[1] 耿擎天[1] 王松[1] 康芳[1] 潘建辉[1] 柴小青[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2014年第2期109-113,共5页Journal of Clinical Anesthesiology

基　　金：安徽省自然科学基金资助项目(11040606M169)

摘　　要：目的评价超声引导下单点或多点胸椎旁神经阻滞(TPVB)联合PCIA在胸腔镜肺叶切除患者的术后镇痛效果。方法选择择期在胸腔镜下行肺叶切除的患者92例,ASAⅠ或Ⅱ级,随机分为单点胸椎旁神经组(O组,n=33)、多点胸椎旁神经组(M组,n=29)和对照组(C组,n=30)。记录TPVB的操作时间、起效时间、阻滞平面,记录入室后、阻滞后15min、手术开始后30、60min及术毕时的BP、HR,记录丙泊酚、瑞芬太尼的用量,患者在麻醉恢复室(PACU)的停留时间和烦躁等的发生情况;分别记录手术后1、2、4、8、12、24、36和48h的VAS评分、术后PCIA舒芬太尼的使用量和患者满意度。结果 O组操作时间和麻醉平面明显低于M组(P<0.05);三组患者各时点MAP、HR差异无统计学意义。C组术中瑞芬太尼用量、PACU停留时间均明显高于O、M组(P<0.05);术后48h内,C组8、12、24、36和48hPCIA舒芬太尼使用量明显多于O、M组(P<0.05);O组患者满意度高于M、C组(P<0.05)。三组均无烦躁等不良反应发生。结论单点TPVB的镇痛作用与多点TPVB无差别,但单点TPVB组操作时间短,患者满意度高,更能让患者接受。Objective The study sought to compare the efficacy of thoracic paravertebral blocks （TPVB） using single-injection PVB or multiple-injection PVB on postoperative analgesia in the lung lobe resection of the video-assisted thoracoscopic surgery （VATS）. Methods Ninety-two patients undergoing VATS were randomly divided into three groups., group O （single-injection PVB group, n=33）; group M（multiple-injection PVB group, n = 29）; group C（control group, n = 30）. An ultrasound-guided PVB was performed before surgery using a solution of 16 ml 0.5% ropivicaine by a single-injection at Ts （group O） or by 4 injections of 4 ml each at T4 to T7 （group M）. The time period to perform the blocks, the numbers of anesthetized dermatomes, onset time, hemodynamics, total remifentanil and propofol used during operation time in postanesthesia care unit （PACU）, the postoperative pain scores and sulfentanil consumption with patient-controlled intravenous analgesia, auxiliary agents, adverse reactions, hospital discharge time and patient satisfaction were recorded. Results Compared with group M, the time period to perform the blocks of group O were longer（P〈 0.05）. The numbers of anesthetized dermatomes in group O were more（P〈0.05）. There were no difference on MAP and HR in the three groups. Compared with group C, the total dosage of remifentanil and time in PACU were decreased in groups O and M （P〈0. 05）. Compared with group C, the dosage of sulfentanil at 8,12,24,36 and 48 h after operation in groups O and M were decreased （P 〈 0.05）. Patient satisfaction with the analgesia was greater in group O （P 〈 0.05）. No complications were attributed to the blocks. Conclusion Single-injection PVB may represent an advantage over multiple-injection PVB in patients undergoing the pulmonary resection of VATS, with greater patient satisfaction associated with a shorter procedure.

关 键 词：椎旁神经阻滞 胸腔镜手术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]