超声引导胸椎旁阻滞治疗胸腔镜手术后早期中重度急性疼痛的疗效观察  

Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video- assisted thoracoscopic surgery

作　　者：刘飞[1] 张静[1] 张欢楷[2] 赵秫琪 梁鹏[1] 左云霞[1] 

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]广东省揭阳市人民医院

出　　处：《中华医学杂志》2017年第2期119-122,共4页National Medical Journal of China

基　　金：四川省卫生和计划生育委员会科研课题（150166）

摘　　要：目的比较超声引导胸椎旁阻滞与阿片类药物治疗麻醉苏醒室胸腔镜手术后患者中重度疼痛的有效性和安全性。方法纳入疼痛剧烈的胸腔镜手术患者78例，数字随机分为超声引导胸椎旁阻滞组（P组）和舒芬太尼治疗组（S组），记录两组患者治疗后1 h血压、心率、氧饱和度和静息/活动疼痛视觉模拟评分（VAS评分），治疗后麻醉苏醒室停留时间，治疗8、24 h和48 h静息/活动疼痛VAS评分，术后48 h自控静脉镇痛泵舒芬太尼总量，恶心呕吐发生率和患者镇痛满意度。结果P组患者治疗后1、8、24、48 h静息和活动疼痛VAS评分明显低于S组患者（P〈0.05）。治疗后1 h，P组患者氧饱和度明显高于S组（95%±3%与92%±4%，P＝0.015），收缩压明显低于S组[（118±14） mmHg比（128±14） mmHg（1mmHg＝0.133 kPa），P＝0.021]，舒张压和心率差异无统计学意义，两组患者治疗后PACU停留时间无显著差异。治疗后48 h P组患者自控静脉镇痛泵舒芬太尼总量明显低于S组，P组患者恶心呕吐发生率明显低于S组。术后镇痛满意度P组患者明显高于S组。结论麻醉苏醒室进行胸椎旁阻滞能够有效迅速缓解胸腔镜手术患者术后中重度急性疼痛，是一种安全有效的补救镇痛方式。Objective To investigate the effectiveness and safety of the thoracic paravertebral block （TPVB） in the post postanesthesia care unit （PACU） for patients suffered moderate to severe pain after Video-Assisted Thoracoscopic Surgery （VATS）. Methods 78 atients who complained moderate to severe pain on arrival to PACU after VATS were randomly assigned into two groups： thoracic paravertebral block treatment group（ P group） and sufentanil treatment group （S group）. The VAS Pain score at rest and movement, heart rate, blood pressure, and pulse oximetry 1 hour after treatment and duration of patients staying in the PACU after treatment were recorded. VAS Pain score at rest and on coughing at 8, 24 and 48 hours after treatment were closely monitored. Sufentanil comsumption, patient satisfaction and related complications were also recorded. Results A successful TPVB was achieved in all patients in P group without puncture related complications. The VAS pain scores at rest and on coughing 1 hour, 8 hours, 24 hours and 48 hours after treatment in P group were significantly lower than the patients in S group. Systolic blood pressure 1 hour after treatment in P group was also lower than the patients in S group（ 118mmHg ± 14mmHg vs 128 mmHg± 14 mmHg,P =0. 021 ）. SPO2 1 hour after treatment in P group was much higher than the patients in S group （95% ± 3% vs 92% ± 4% ,P = 0. 015）. The duration of patients staying in the PACU after treatment in both groups were similar. Sufentanil comsumption, rate of vomiting and nausea was significantly less and satisfaction was better in P group than thoses in S group. Conclusion In the postanesthesia care unit, TPVB could provide effective and safe analgesia therapy for patients suffered from moderate to severe pain after VATS.

关 键 词：胸椎旁阻滞 胸腔镜手术 术后急性疼痛 麻醉苏醒室 

分 类 号：R614[医药卫生—麻醉学]