超声引导下平面内经外侧肋间入路行胸椎旁阻滞的临床评价  

Clinical evaluation of in-plane ultrasound-guided thoracic paravertebral block using laterally intercostal approach

作　　者：许挺[1] 李民[1] 田杨[1] 宋金涛[2] 倪诚[1] 郭向阳[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191 [2]北京大学第三医院胸外科,北京100191

出　　处：《北京大学学报（医学版）》2017年第1期148-152,共5页Journal of Peking University:Health Sciences

摘　　要：目的:评估在超声引导下采用平面内方法,经外侧肋间入路行胸椎旁阻滞技术的可行性和成功率。方法:选取27例择期行胸外科手术的患者,于术前进行胸椎旁阻滞。超声探头置于脊柱旁8 cm左右,平行肋骨长轴在第5肋间隙进行扫描,以肋间内肌和肋间最内肌之间的间隙作为穿刺目标进针,穿刺针到达目标区域后,推注0.5%(质量分数)罗哌卡因20 m L后置管,在超声下评估导管头端位置是否良好,记录给药后10、20、30 min冷触觉阻滞平面。术后连接镇痛泵经导管持续泵注0.2%罗哌卡因6 m L/h进行镇痛,记录术后1、6、24、48 h冷触觉阻滞平面及疼痛程度评分。结果:1次置管成功率81.48%(22/27),另5例患者分别在第2次置管和第3次置管后成功。给予负荷剂量给药后10、20、30 min冷触觉阻滞平面数中位数分别为2、3、4,术后1、6、24、48 h冷触觉阻滞平面数及疼痛程度评分中位数分别为5、5、5、4以及1、1、2、2,无患者发生双侧阻滞、气胸及误穿血管等并发症。结论:采用上述外侧肋间入路技术进行胸椎旁阻滞具有良好的可行性,阻滞成功率高,并发症少。Objective： To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach. Methods： In the study,27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively. The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine. The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles. Once the space between the muscles was achieved,20 m L of 0. 5%（ mass fraction） ropivacaine was injected and a catheter was inserted. Whether the tip of catheter was in right place was evaluated by ultrasound image. The block dermatomes of cold sensation were recorded 10,20 and 30 min after the bolus drug was given. Then 0. 2% ropivacaine was infused with 6 m L/h via the catheter by an analgesia pump postoperatively. The block dermatomes of cold sensation and pain score were recorded 1,6,24 and 48 h postoperatively. Results： The first attempt success rate of catheteration was 81. 48%（ 22/27）; the tips of catheter were proved in right places after the second or third attempt in 5 patients. The median numbers of the block dermatomes 10,20 and 30 min after the bolus drug was given were 2,3,4; the median numbers of block dermatomes were 5,5,5,4,and of pain score were1,1,2,2 at 1,6,24,48 h postoperatively; no case of bilateral block,pneumothorax or vessel puncture occurred. Conclusion： Thoracic paravertebral block using laterally intercostal approach is feasible,which has high success rate of block and low rate of complications.

关 键 词：胸外科手术 麻醉 局部 胸椎旁阻滞 超声检查 肋间肌 

分 类 号：R697.24[医药卫生—泌尿科学]