超声引导下不同部位神经阻滞用于胸腔镜手术镇痛的对比研究  

Effect of ultrasound-guided single ESP block and TPVB on postoperative self-controlled intravenous analgesia in patients underwent video-assisted thoracoscopic lobectomy

作　　者：杨建兵[1] 王浩杰[1] 严峰[1] Jian-bin Yang;Hao-jie Wang;Feng Yan(Department of Anesthesiology,Yuyao People’s Hospital,Yuyao,Zhejiang 315400,China)

机构地区：[1]浙江省余姚市人民医院麻醉科,浙江余姚315400

出　　处：《中国内镜杂志》2018年第8期36-41,共6页China Journal of Endoscopy

基　　金：浙江省宁波市医学科技计划项目(No:2017A53)

摘　　要：目的观察超声引导下胸椎旁神经阻滞(TPVB)和胸椎竖脊肌平面神经(ESP)阻滞两种不同的神经阻滞方法用于胸腔镜肺叶切除手术镇痛的对比研究。方法选择行胸腔镜下肺叶切除术患者40例,美国麻醉医师协会分级(ASA)Ⅰ或Ⅱ级。随机分为胸椎ESP阻滞联合静脉自控镇痛泵(PCIA)组(P组)和TPVB联合PCIA组(C组)。P组麻醉诱导前行ESP,C组行TPVB,20 min后测定阻滞范围,术后两组均采用PCIA静脉镇痛。记录两组患者的术后1、6、12和24 h的静息和咳嗽时视觉模拟评分(VAS),镇痛泵按压次数和输注总量以及术后不良反应发生率。结果胸椎ESP阻滞在20 min后可阻滞T2~T6或T2~T7脊神经支配节段,TPVB为T2~T7脊神经支配节段,手术后1~24 h两组患者静息和咳嗽时VAS评分在1、6和12 h无明显差异(P>0.05),在18和24 h差异有统计学意义(P<0.05)。患者术后镇痛泵按压次数、输注总量对比无明显差异(P>0.05)。两组患者在术后恶心、呕吐等不良反应发生率对比差异无统计学意义(P>0.05)。结论超声引导下胸椎ESP阻滞联合PCIA的胸腔镜手术镇痛方式在胸腔镜肺叶切除术中有较好的镇痛效果,可以推广使用。Objective To observe the effect of ultrasound-guided single ESP block and TPVB combinedwith patient-controlled intravenous analgesia （PCIA） on postoperative analgesia in patients undergoing lobectomyperformed via videoassisted thoracoscope. Methods Forty patients （ASA physical statusⅠorⅡ）, scheduled forelective videoassisted thoracoscopic lobectomy, were randomly assigned into two groups, ESP block combined withPCIA group （group P） and TPVB block combined with PCIA group （group C）. ESP block was given to patientsin group P before operation, TPVB block was given to patients in group C before operation ,and its effect wasevaluated by testing the area of block. VAS scores were recorded at l, 6, 12, and 24 h after operation. The frequencyfor compress PCIA, the volume of analgesic drugs, and the side effects were recorded as well. Results ESP blockwas accomplished in group P with sensory loss from T2 - T6 or T2 - T7 over the entire posterolateral aspect of thehemithorax. TPVB block was accomplished in group C with sensory loss from T2 - T7 over the entire posterolateral aspect of the hemithorax. The VAS scores both at rest and coughing in group P and group C were no significantlydifferent in 1 h, 6 h, 12 h （P 〉 0.05）, there are different in 18 h and 24 h （P 〈 0.05）. The compress PCIA numbers,the volume of analgesic drugs and the consumption of morphine were no significant different （P 〉 0.05）. Nauseaand vomiting were observed as postoperative side effects, and there were no significant differences between the twogroups. Conclusion Ultrasound-guided single ESP block combined with PCIA is a safer and effective method for theanalgesia of thoracic operation.

关 键 词：超声引导 胸椎竖脊肌平面阻滞 胸椎旁神经阻滞 电视辅助胸腔镜手术 肺叶切除 静脉自控镇痛泵 

分 类 号：R614.2[医药卫生—麻醉学]