超声引导连续胸椎旁神经阻滞对老年患者开胸术后镇痛的效果  

The analgesic effect of ultrasound-guided continuous paravertebral nerve block after thoracotomy in elderly patients

作　　者：叶伟光[1] 卜丹[1] 王天龙[1] Ye Weiguang Bu Dan Wang Tianlong.(Department of Anesthesiology, Xuanwu Hospital ,Capital Medical University, Beijing 100053, China)

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2017年第3期236-239,共4页Beijing Medical Journal

基　　金：北京市医院管理局"登峰"计划(DFL20150802)

摘　　要：目的探讨胸椎旁阻滞对老年患者开胸手术术后镇痛的效果。方法选择开胸行肺叶切除术的老年患者60例,年龄65~79岁,美国麻醉医师协会(ASA)麻醉风险分级II~Ⅲ级。随机数字表法将患者分为连续胸椎旁神经阻滞组(A组)和静脉镇痛组(B组),A组于术毕拔管后在超声引导下连续行胸椎旁神经阻滞,经导管注药0.2%罗哌卡因5 ml负荷量,镇痛泵配方为0.2%罗哌卡因250 ml,运行方案为5 ml/h;B组于术毕缝皮前开启经静脉自控镇痛,镇痛泵配方为舒芬太尼2μg/ml稀释至100 ml,运行方案为2 ml/h。视觉模拟评分法(VAS)评估镇痛效果,Ramsay评分法评估镇静程度,观察术后恶性呕吐程度,术后镇痛满意度、术后不良反应发生情况。结果 A组患者在超声引导下均顺利完成胸椎旁神经阻滞置管,未发生穿刺相关并发症。与B组比较,A组术后6、12、24、48h的VAS评分明显降低,镇痛效果好,满意度高(P<0.05)。A组未出现恶心呕吐及嗜睡等不良反应,B组共发生7例,差异有统计学意义(P<0.05)。结论超声引导连续胸椎旁神经阻滞用于老年患者开胸术后镇痛效果确切,不良反应少。Objective To observe the analgesic effect of continuous paravertebral nerve block after thoracotomy in elderly patients. Methods Sixty ASA II-III patients, aged 65-79 years old, scheduled for lobectomy were randomly assigned into two groups： the CPVB group（group A） and the patient-controlled intravenous analgesia group（PCIA,group B）. Patients in group A received continuous paravertehral block after extubation. 5ml loading dose of 0.2% ropivacaine were given through the catheter（PCNA formula： 250 ml 0.2% ropivacaine, 5 ml/h）. The patients in group B was started at the time of suture（PCIA formula： sulfentanyl 2μg/ml,2 ml/h）. VAS were used to evaluate analgesic effect and the Ramsay scores were used to evaluate the level of sedation. The side effects such as nausea and vomiting, postoperative analgesia satisfaction were recorded. Results All patients in group A were successfully performed with CPVB guided by ultrasound without puncture-related complications. Compared with group B, the VAS at 6,12,24,48 h after the surgery in group A decreased significantly（P〈0.05） with higher analgesia satisfaction（P〈0.01）. Group A showed no adverse effects such as nausea, vomiting or drowsiness, while 7 cases in group B developed such adverse effects. Conclusion Continuous thoracic paravertebral block guided by ultrasound in elderly patients provides adequate analgesic effect after thoracotomy with low incidence of side effects.

关 键 词：老年 椎旁阻滞 术后镇痛 

分 类 号：R614[医药卫生—麻醉学] R445.1[医药卫生—外科学]