B超引导椎旁阻滞在肝癌手术中的应用研究  

Study on the application of B-ultrasound guided paravertebral block in liver cancer surgery

作　　者：朱韵甜[1] 张润泽[1] 周大春[2] 方军[1] 

机构地区：[1]浙江省肿瘤医院麻醉科,浙江杭州310022 [2]浙江大学医学院附属邵逸夫医院麻醉科,浙江杭州310016

出　　处：《中国现代医生》2017年第2期104-107,共4页China Modern Doctor

基　　金：浙江省自然科学基金资助项目(Y2110421)

摘　　要：目的探讨B超引导下椎旁神经阻滞在肝脏手术中的镇痛作用及其与传统硬膜外镇痛的差异。方法选取行剖腹肝癌切除术的患者60例,随机分成全麻复合硬膜外麻醉组(E组)和全麻复合椎旁阻滞组(P组),E组行硬膜外穿刺置管,P组在B超引导下行椎旁神经阻滞。术后E组采用硬膜外镇痛,P组采用静脉镇痛。对两组患者术中瑞芬太尼和麻黄碱用量,拔管后15 min(T0)、术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)的镇痛效果及术后并发症进行比较。结果 E组术中麻黄碱用量较多[(2.17±3.64)mg,P<0.05],两组术后各时点的视觉模拟评分(VAS)及术后镇痛按压次数、术后恶心呕吐(PONV)发生率差异无统计学意义(P>0.05)。结论在肝脏手术中,椎旁阻滞联合术后静脉阿片类及非阿片类药物的多模式镇痛法,能达到不弱于硬膜外镇痛的术中及术后镇痛效果,且对血流动力学影响更小,术后不良反应更少。Objective To study the analgesic effect and explore its difference from traditional epidural hepatectomy were selected in the study. They were of B-ultrasound guided paravertebral nerve block in liver surgery analgesia. Methods A total of 60 patients undergoing abdominal randomly divided into general anesthesia combined with epidural anesthesia group（group E） and general anesthesia combined with paravertebral block group （group P）. Group E was given epidural catheter, and group P was given B-ultrasound guided paravertebral nerve block. Group E was given epidural analgesia and group P was given intravenous analgesia after the surgery. The dosage of remifentanil and ephedrine in the surgery, the analgesic effect 15 min（T0） after extubation, 6 h （T1）, 12 h （T2）, 24 h （T3）, and 48 h （T4） after surgery, and the postoperative complications were compared between the two groups. Results The dosage of ephedrine during the surgery was significantly higher in group E [（2.17±3.64） mg, P〈0.05]. There was no significant difference in visual analogue scale（VAS）, postoperative analgesia pressing times and incidence rate of postoperative nausea and vomiting （PONV） between the two groups （P〉O.05）. Conclusion In the liver surgery, paravertebral nerve block combined with the multimodal analgesia of postoperative intravenous injection of opioid and non-opioid drugs can achieve the intraopera- tive and postoperative analgesic effect, which is not weaker than that of epidural analgesia. This method shows less ef- fects on hemodynamics, and the postoperative adverse reactions are fewer.

关 键 词：B超引导 椎旁神经阻滞 硬膜外镇痛 多模式镇痛 

分 类 号：R614[医药卫生—麻醉学] R735.7[医药卫生—外科学]