开胸前后超声引导胸椎旁间隙阻滞的镇痛效果比较  

Comparison of analgesic efficacy of ultrasound-guided thoracic paraver-tebral block before and after thoracotomy

作　　者：许莉[1] 周雁[1] 袁嫕[1] 林惠华[1] 伊军[1] 王庚[1] 

机构地区：[1]北京积水潭医院麻醉科,北京100035

出　　处：《中国医药导报》2015年第5期86-90,共5页China Medical Herald

摘　　要：目的 比较开胸前后单次超声引导下胸椎旁间隙阻滞的术后镇痛效果。方法 试验设计采用随机双盲对照试验,选择ASAⅠ~Ⅱ级、年龄18~65岁、拟全麻下行侧卧位开胸手术的患者40例,随机分为两组：开胸前组和开胸后组。选择切口对应胸椎旁间隙进行超声引导下胸椎旁间隙阻滞,单点注射0.5%罗哌卡因30 m L。开胸前组阻滞在全麻诱导后、术野消毒前进行,开胸后组阻滞在手术缝皮结束后、气管拔管前进行。所有患者均使用舒芬太尼静脉自控镇痛。记录术后1、4、8、12、24、48 h静息及运动（咳嗽）视觉模拟评分（VAS）;记录术后镇痛泵首次按压时间;记录术后舒芬太尼的消耗量及恶心、呕吐、过度镇静及呼吸困难等不良反应的发生情况。结果 开胸前组术后8 h静息VAS评分[M（Q）][2.0（1.0）比3.5（1.0）,P〈0.01]及运动VAS评分[2.5（1.8）比5.5（2.8）,P〈0.01]、12 h静息VAS评分[2.0（1.0）比3.0（2.0）,P〈0.01]及运动VAS评分[3.0（1.8）比5.0（2.0）,P〈0.01]均低于开胸后组。两组其余各观察点（术后1、4、24、48 h）静息及运动VAS评分比较差异均无统计学意义（P〉0.05）。开胸后组舒芬太尼首次觅求时间明显早于开胸前组[（476.5±103.3）min比（999.8±115.9）min,P〈0.01],开胸后组术后0~12 h和12~24 h舒芬太尼消耗量也明显高于开胸前组[（14.7±4.3）μg比（6.6±2.4）μg,（23.6±6.3）μg比（15.8±4.4）μg,P〈0.01]。两组患者均未发生术后呼吸困难。两组术后镇静评分和术后恶心呕吐的发生率比较差异无统计学意义（P〉0.05）。结论 开胸前及开胸后超声引导下胸椎旁间隙阻滞均可为开胸手术提供良好的术后早期镇痛,但开胸前胸椎旁间隙阻滞镇痛时间更长、镇痛效果更佳。Objective To observe the postoperative analgesic efficacy of single uhrasound-guided thoracic paravertebral block before and after thoracotomy. Methods The experiment design used randomized, double-blind controlled trial, 40 cases of patients with ASA Ⅰ - Ⅱ, 18-65 years old, undergoing lateral position of thoracotomy under general anesthesia were randomly divided into two groups： before thoracotomy group and after thoracotomy group. The incision corresponding thoracic paravertebral gap was chosen to take thoracic paravertebral block, and 0.5% Ropivacaine of 30 mL was single injected. The block of before thoracotomy group was taken at general anesthesia induction later and before disinfection of surgery field, which of after thoracotomy group was taken at the end of surgery skin seam. All patients received Sufentanil patient-controlled intravenous analgesia. The resting and athletic （cough） visual analogue scale （VAS） at postoperative 1, 4, 8, 12, 24, 48 h was recorded; the first pressing time of epidural analgesic tube after operation was recorded; the consumption of Sufentanil and adverse reactions such as nausea, vomiting, excessive sedation and dyspnea after operation were recorded. Results The resting VAS scores at postoperative 8 h [M （Q）] [2.0 （1.0） vs 3.5 （1.0）, P 〈 0.01] and athletic VAS scores at postoperative 8 h [2.5 （1.8） vs 5.5 （2.8）, P 〈 0.01], the resting VAS scores at postoperative 12 h [2.0 （1.0） vs 3.0 （2.0）, P 〈 0.01] and athletic VAS scores at postoperative 12 h [3.0 （1.8） vs 5.0 （2.0）, P 〈 0.01] in before thoracotomy group were all lower than those of after thoracotomy group. There were no statistically significant differences of resting and athletic VAS scores in other observation points （postoperative 1, 4, 24, 48 h） between the two groups （P 〉 0.05）. The first begging time of Sufentanil in after thoracotomy group was significantly earlier than that of before thoracotomy group [（476.5±103.3） min vs （999.8±115.9） r

关 键 词：胸椎旁间隙阻滞 镇痛 超声引导 开胸术 

分 类 号：R614.4[医药卫生—麻醉学]