全麻复合胸椎旁阻滞对单孔胸腔镜手术术后疼痛及快速康复的影响  

Effects of general anesthesia combined thoracic paravertebral block on postoperative pain and fast track in single-port video-assisted thoracoscopic surgery

作　　者：朱雁铃 彭捷[1] 吴友平[1] 谢洁红[1] 张兴安[1] 屠伟峰[1] 

机构地区：[1]南方医科大学附属广州军区广州总医院麻醉科,510010

出　　处：《临床麻醉学杂志》2015年第12期1153-1156,共4页Journal of Clinical Anesthesiology

基　　金：广东省科技计划项目(2012B031800417)

摘　　要：目的：探讨全麻复合超声引导下单次胸椎旁阻滞对单孔胸腔镜手术患者术后疼痛和快速康复的影响。方法择期行单孔胸腔镜手术的患者30例,男20例,女10例,采用随机数字表法将患者分为两组,每组15例。C 组采用单纯全凭静脉麻醉,T 组于麻醉诱导前采用超声引导下单次椎旁神经阻滞,术中行全凭静脉麻醉。两组患者术后均不采用镇痛装置,若术后静息时 VAS 评分〉4分,则予单次剂量地佐辛5~20 mg,一天最多不超过120 mg。记录术后1、4、8、12 h 的 Ramsay镇静评分,术前1 d、术后4、8、12、24 h 的机械痛阈值,术后第1次疼痛反馈时间,术后24 h 内地佐辛用量及不良反应情况,第1次下床活动时间和术后住院时间。结果与 C 组比较,T 组术后8、12 h Ramsay 评分明显降低（P 〈0.05）,术后4、8 h 机械痛阈值明显升高（P 〈0.05）,第1次疼痛反馈时间明显延长（P 〈0.05）,术后24 h 内地佐辛用量明显减少（P 〈0.05）,第1次下床活动时间和住院时间明显缩短（P 〈0.05）,术后24 h 恶心呕吐等不良反应发生率明显降低（P 〈0.05）。结论全麻复合单次胸椎旁阻滞可有效缓解单孔胸腔镜手术患者术后的切口疼痛,减少术后24 h 内阿片类药物用量,降低不良反应发生,有利于术后早期下床活动,缩短患者住院时间。Objective To explore the effects of general anesthesia combined thoracic paraverte-bral block on postoperative pain and fast track single-port video-assisted thoracoscopic surgery （VATS）.Methods Thirty patients,including male 20 and female 10,received single-port VATS were randomly and equally divided into two groups：group C received general anesthesia only,and group T received ultrasound-guided thoracic paravertebral nerve block combined with general anesthe-sia.Both groups did not use the patient-controlled analgesia,if insufficient analgesia happened （rest-ing VAS scores〉4）,than used dezocine intravenously as additional analgesia （a single-dose 5-20 mg, no more than 120 mg per day）.The Ramsay scores at 1,4,8,12 h after the surgery and the mechani-cal withdrawal threshold on the day before the surgery,at 4,8,12,24 h after the surgery were recor-ded.The first time of post-operation pain feedback,the consumption of dezocine in the first 24 h after surgery,the incidence rates of side effects,the first time off-bed and the hospital stays were also re-corded.Results Compared with group C,the Ramsay scores at 8,12 h postoperatively in group T significantly decreased （P 〈0.05）,and the mechanical withdrawal threshold at 4,8 h postoperatively significantly increased （P 〈0.05）.The first time of post-operation pain feedback in group T was sig-nificantly longer than group C （P 〈0.05）.The consumption of dezocine in the first 24 h after surgery significantly decreased in group T （P 〈0.05）.The first time off-bed and the hospital stays in group T were shorter than group C （P 〈0.05）.Also,the incidence rates of nausea,vomiting in the first 24 h postoperatively were lower in group T （P 〈 0.05 ）.Conclusion General anesthesia combined with single-injected thoracic paravertebral nerve block can effectively relieve the postoperative pain in pa-tients undergoing single-port VATS,reduce the consumption of opioids in the first 24 h postopera-tively,cutting down the occurring rates of a

关 键 词：胸椎旁阻滞 单孔胸腔镜手术 镇痛 快速康复 

分 类 号：R614.2[医药卫生—麻醉学]