神经刺激器引导连续胸椎旁神经阻滞在肾切除患者术后镇痛中的应用  

Application of continuous thoracic paravertebral nerve block guided by nerve stimulator on postoperative pain relief for nephrectomy

作　　者：张蔚青[1] 万政佐[1] 周蓉[1] 徐珂[1] 肖萍[1] 梁志鹏[1] 李亚楠[1] 丁帅[1] 汪丽凤 鲁凯[1] 

机构地区：[1]浙江省杭州市中医院麻醉科,310007

出　　处：《中华医学杂志》2014年第23期1812-1814,共3页National Medical Journal of China

摘　　要：目的：评价肾切除术后采用连续椎旁神经阻滞镇痛的疗效。方法选择2012年2月至2013年11月杭州市中医院泌尿外科拟行单纯性肾脏切除术患者60例，美国麻醉医师协会（ ASA）分级Ⅰ～Ⅱ级，年龄30～65岁，体质量45～80 kg，性别不限，经医院伦理委员会审核通过。采用随机数字表法，将患者随机分为2组：硬膜外阻滞组（ CEA 组）及连续椎旁神经阻滞组（ PVB组），每组30例。两组均连续输注0.2％罗哌卡因250 ml，并采用静脉吗啡患者自控辅助镇痛。于术后6、12、24及48 h分别检测血气，并评估安静和运动状态时的视觉模拟评分（ VAS），统计术后48 h两组患者吗啡累计用量及并发症的发生率。结果与CEA组相比， PVB组PaO2明显升高，PaCO2明显降低，运动VAS评分明显降低，吗啡累积用量减少[（5.2±1.2）比（13.9±1.6）mg]，恶心、呕吐、皮肤瘙痒、体位性低血压患者数明显减少，术毕至首次肛门排气的时间间隔短（P＜0.05），而两组各点安静VAS评分差异无统计学意义。结论开放性肾切除术后采用PVB镇痛较CEA镇痛可减少术后吗啡用量及相关并发症，有利于患者恢复。Objective To evaluate the effects of continuous paravertebral nerve block after nephrectomy.Methods 60 cases receiving simple nephrectomy , American Society of Anesthesiologists （ASA） grading status Ⅰor Ⅱ, aged from 30 to 65 years, weighing from 45 to 80 kg, male or female,were randomly divided into 2 groups：control group （ CEA group ） and continuous paravertebral nerve block group （ PVB group ） , 30 patients in each one.Both groups were performed with 0.2% ropivacaine 250 ml in continuous infusion , assisted with intravenous morphine patient-controlled analgesia.The blood gas was examined in 6,12,24 and 48 h postoperatively, and the VAS scores of quiet state and motion state were assessed.In 48 h postoperation ,the total amount of morphine was calculated and the complications cases were recorded.Results Compared with the CEA group , PaO2 in PVB group increased and PaCO 2 declined significantly.There was no difference of VAS score under quiet state , but under the motion state the VAS scores declined significantly,the total amount of morphine reduced [（5.2 ±1.2） vs （13.9 ±1.6）mg）], the cases of nausea , vomiting , pruritus , orthostatic hypotension decreased and the postoperative first anal exhaust time interval shortened （P〈0.05）.Conclusion Compared with CEA,postoperative administration of PVB for open nephrectomy results in lowering morphine dose as well as side effect related with the use of morphine.

关 键 词：胸椎旁 酰胺类 疼痛 手术后 镇痛 

分 类 号：R614[医药卫生—麻醉学]