超声引导下连续胸椎旁神经阻滞用于肺癌根治术后的镇痛效果  

Postoperative analgesia effect of ultrasound-guided continuous thoracic paravertebral nerve block in radical surgery of lung cancer

作　　者：金鑫[1] 夏燕飞[1] 卢星[1] 

机构地区：[1]浙江医院麻醉科,浙江杭州310000

出　　处：《中国现代医生》2016年第1期129-131,共3页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2014KYB016)

摘　　要：目的观察超声引导下连续胸椎旁神经阻滞用于肺癌根治术后的镇痛效果。方法选取我院2013年7月~2014年7月行肺癌根治术患者40例,ASAⅠ或Ⅱ级,随机均分为两组,常规全身麻醉组（A组）和在超声引导下连续胸椎旁神经阻滞后行全身麻醉组（B组）,术后A组患者静脉持续输注舒芬太尼镇痛,B组患者超声引导下罗哌卡因连续胸椎旁神经阻滞镇痛,两组均持续镇痛48 h。记录术后2、4、8、12、24和48 h的疼痛视觉模拟（VAS）评分,记录患者术后48 h按压镇痛泵次数和不良反应发生情况。结果 B组在术后各时间点静息和运动时的疼痛VAS评分均显著低于A组（P〈0.05）;A组有效按压次数明显高于B组（P〈0.05）;A组5例患者术后出现不良反应,B组未观察到明显的不良反应。结论超声引导下连续胸椎旁阻滞0.25%罗哌卡因用于肺癌根治术患者,术后镇痛效果较好,并发症发生率也较低,是肺癌根治术后较为理想的镇痛方法。Objective To observe the postoperative analgesia effect of ultrasound-guided continuous thoracic paravertebral nerve block in radical surgery of lung cancer. Methods From July 2013 to July 2014, 40 cases of lung cancer surgery patients with Ⅰ or Ⅱ grade of ASA grading in our hospital were selected, they were divided into two groups randomly（n=20）： general anesthesia group（group A） and ultrasound-guided thoracic paravertebral block combined with general anesthesia group（group B）. After operation, the patients in group A received continuous infusion of intravenous sufentanil and the patients in group B received thoracic paravertebral block with ropivacaine for two days. Visual analog scale（VAS） scores were recorded at 2, 4, 8, 12,24, and 48 h after operation. The frequency of compressing PCA and adverse reactions were recorded as well. Results The VAS scores of group B at each time point after operation were significantly lower than that of group A（P〈0.05）. The frequencies of compressing PCA in group A were significantly higher than that in group B（P〈0.05）, five patients suffered postoperative adverse reactions in group A, and no obvious adverse reaction was observed in group B. Conclusion Ultrasound-guided continuous thoracic paravertebral nerve is an ideal analgesic method for radical resection of pulmonary carcinoma with better analgesic effect, and fewer side effects.

关 键 词：超声引导 胸椎旁神经阻滞 肺癌 根治术后 镇痛 

分 类 号：R734.2[医药卫生—肿瘤]