胸腔镜直视下经胸腔入路胸椎旁神经阻滞对肺叶切除术患者术后镇痛效果的影响  

Effect of thoracic approach to thoracic paravertebral blockade performed via video-assisted thoracoscope on postoperative analgesia in patients undergoing lobectomy

作　　者：洪甲庚[1] 聂洋洋 林绍立[1] 刘风[2] Hong Jiageng;Nie Yangyang;Lin Shaoli;Liu Feng(Department of Anesthesiology,First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Fifth Hospital of Xiamen,Xiamen 361101,China)

机构地区：[1]厦门大学附属第一医院麻醉科,361003 [2]厦门市第五医院(厦门大学附属第一医院翔安院区)麻醉科,361101

出　　处：《中华麻醉学杂志》2018年第8期946-949,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价胸腔镜直视下经胸腔入路胸椎旁神经阻滞对肺叶切除术患者术后镇痛效果的影响.方法 择期胸腔镜单侧肺叶切除术患者84例,年龄44~64岁,BMI 19.7~24.9 kg∕m^2,ASA分级Ⅱ或Ⅲ级,性别不限.采用随机数字表法分为2组(n=42):胸椎旁神经阻滞组(TP组)和对照组(C组).关胸前TP组胸腔镜直视下胸腔入路患侧胸椎旁神经阻滞,注入0.375%盐酸罗哌卡因20 ml,随后2组均行PCIA,配方为地佐辛0.6 mg∕kg、氟比洛芬酯200 mg、帕洛诺司琼0.5 mg、地塞米松10 mg,配至120 ml,负荷剂量5 ml,背景剂量2 ml∕h,PCA 0.5 ml,锁定时间15 min.记录手术时间;于术前、术后6、24和48 h时记录最大呼气流速;于术后24和48 h记录地佐辛累积用量和按压次数;记录术后嗜睡、头晕、恶心呕吐的发生情况;VAS评分≥4分时静脉注射曲马多2 mg∕kg补救镇痛.结果 与C组比较,TP组术后24和48 h时地佐辛累积用量和按压次数减少,镇痛补救率和头晕、恶心呕吐发生率降低,术后6 h时最大呼气流速增高(P<0.05).结论 胸腔镜直视下经胸腔入路胸椎旁神经阻滞可增强胸腔镜肺叶切除术患者术后镇痛效果.Objective To evaluate the efficacy of the thoracic approach to thoracic paravertebral blockade ( PVB) performed via video-assisted thoracoscope on postoperative analgesia in patients undergoing lobectomy. Methods A total of 84 patients of both sexes, aged 44-64 yr, with body mass index of 19. 7-24. 9 kg∕m^2 , of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective vide-o-assisted thoracoscopic unilateral lobectomy, were divided into 2 groups ( n=42 each) using a random number table method: thoracic PVB group (TP group) and control group (C group). In TP group, the thoracic approach to thoracic PVB was performed on the affected side via video-assisted thoracoscope before closing the chest, and 0. 375% ropivacaine hydrochloride 20 ml was injected. Then patient-controlled intra-venous analgesia ( PCIA) was performed in both groups. PCIA solution contained dezocine 0. 6 mg∕kg, flurbiprofen axetil 200 mg, palonosetron 0. 5 mg and dexamethasone 10 mg in 120 ml of normal saline. The PCA pump was set up with a 0. 5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml∕h after a loading dose of 5 ml. Duration of operation was recorded. The peak expiratory flow rate ( PEFR) was recorded before surgery and at 6, 24 and 48 h after surgery. The amount of dezocine and pressing times of PCA were recorded at 24 and 48 h after surgery. The occurrence of drowsiness, dizziness, nausea and vomiting was recorded after surgery. Tramadol 2 mg∕kg was intravenously injected as rescue an-algesic when visual analog scale score≥4 points. Results Compared with group C, the amount of dezo-cine and pressing times of PCA were significantly reduced at 24 and 48 h after surgery, the requirement for rescue analgesia and incidence of nausea and vomiting were decreased, and the PEFR was increased at 6 h after operation in group TP ( P<0. 05) . Conclusion The thoracic approach to PVB performed via video-assisted thoracoscope can enhance the efficacy of postoperative analgesia in

关 键 词：神经传导阻滞 疼痛 手术后 胸腔镜检查 

分 类 号：R614[医药卫生—麻醉学]