胸段椎旁阻滞联合静脉自控镇痛在腔镜肾切除患者术后镇痛中的应用  

Efficacy of thoracic paravertebral block combined with patient-controlled intravenous analgesia for postoperative analgesia in patients after laparoscopic nephrectomy

作　　者：白武民[1] 路文胜[1] 张双银[1] 白洁[1] 张凯 李斌[2] 

机构地区：[1]兰州大学第二医院麻醉科,兰州市730030 [2]兰州大学第二医院胸外科,兰州市730030

出　　处：《实用疼痛学杂志》2017年第5期353-357,共5页Pain Clinic Journal

基　　金：甘肃省自然科学基金（项目编号：17JR5RA244）

摘　　要：目的观察胸段椎旁阻滞（TPVB）联合静脉自控镇痛对腔镜肾切除患者术后镇痛的效果。方法择期全麻下行腔镜。肾切除术患者60例，根据不同的术后镇痛方案随机分为联合镇痛组和静脉自控镇痛组。联合镇痛组采用胸段椎旁阻滞复合静脉自控镇痛，静脉自控镇痛组单独应用静脉自控镇痛（PCIA）。联合镇痛组患者用超声定位T10-T11椎旁间隙，实时监测下注射0．375％罗哌卡因15ml，术后PCIA配方为舒芬太尼100I．Lg与昂丹司琼16mg用生理盐水稀释至100ml，背景输注量2ml／h，锁定时间15min。记录术后1、3、6、12、24h时静息活动状态NRS疼痛评分。用便携式肺功能仪测定术前用力肺活量（FVC）作为基础值，于术后1、3、6、12、24h时测定FVC，在此期间评定运动状态NRS疼痛评分。记录24h内舒芬太尼消耗量及恶心、呕吐等并发症发生例数。结果联合镇痛组患者术后各时点静息NRS评分及舒芬太尼消耗量均低于静脉自控镇痛组（P〈O．05），两组均未发现需要干预的较严重恶心、呕吐病例及椎管内阻滞等相关并发症。联合镇痛组患者术后各时间点FVC值明显高于静脉自控镇痛组，运动NRS评分低于静脉自控镇痛组（P〈0．05）。结论单次胸段椎旁阻滞联合术后PCIA可以明显降低静息与运动疼痛评分，减少阿片类药物用量，增加肺活量。胸段椎旁阻滞用于腹部手术患者术后镇痛是安全有效的，有利于患者快速康复。Objective To evaluate whether adding a single thoracic paravertebral block （TPVB） to patient-controlled intravenous analgesia （PCIA） would improve postoperative analgesia compared with PCIA alone in patients after laparoscopie nephreetomy. Methods Sixty patients undergoing laparoscopic nephrectomy, were randomly divided into combined analgesia group and PCIA group. The patients were treated with TPVB combined with PCIA in combined analgesia group, and PCIA alone in PCIA group. 0.375% ropivacaine 15 ml was injected into paravertebral space between T^0 and T^I by ultrasound guidance. PCIA contained sufentanil 100 g plus ondansetron 16 mg diluted to 100 ml with normal saline, background dosage 2 ml/h, locking time 15 min. The resting and movement NRS and sufentanil consumption were recorded at 1, 3, 6, 12 and 24 h after the surgery. The forced vital capacity （FVC） was assessed at 1, 3, 6, 12 and 24 h after the surgery. The complications were observed within 24 hours. Results The resting NRS and sufentanil consumption of patients in combined analgesia group were lower than those in patient-controlled intravenous analgesia group at all time points after the surgery （P〈0.05）. No serious complications such as nausea, vomiting and intravertebral block were found in the two groups. The FVC of patients was significantly higher, movement NRS was lower in combined analgesia group than those in patient-controlled intravenous analgesia group at all time points after the surgery （P〈0.05）. Conclusion Adding a single thoracic paravertebral block （TPVB） to postoperative intravenous patient-controlled analgesia can significantly reduce the resting and movement pain score, reduce opioid dosage and increase lung capacity in patients after laparoseopic nephreetomy.

关 键 词：神经传导阻滞 镇痛 病人控制 腹腔镜 肾切除术 

分 类 号：R614[医药卫生—麻醉学]