胸椎旁神经阻滞技术的应用进展  

Application progress of thoracic paravertebral nerve block

作　　者：刘颖 谢冕[1] LIU Ying;XIE Mian(Department of Anesthesiology,Chongqing Traditional Chinese Medical Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院麻醉科,重庆400021

出　　处：《局解手术学杂志》2018年第9期688-692,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的对胸椎旁神经阻滞(TPVB)在胸部手术中的应用进行综述,就不同椎旁阻滞技术的适应证及优势、不足进行比较,并对其与传统硬膜外镇痛的并发症进行比较。方法通过文献综述对TPVB的体表标记入路、超声引导技术、压力测量技术、神经刺激技术等入路的适应证及优缺点进行比较,并对TPVB与传统硬膜外镇痛的并发症进行比较。结果体表标记入路、超声引导技术、压力测量技术、神经刺激技术均可安全有效地完成椎旁神经阻滞,其中超声引导下TPVB操作简便,成功率较其他方式更高而并发症发生率更低。TPVB与硬膜外镇痛比较其效果相当,而低血压、呼吸抑制、尿潴留、阻滞不完全或阻滞失败等并发症发生率更低。结论超声引导下TPVB操作简便,成功率高,穿刺并发症少,在胸部及上腹部手术围术期镇痛效果确切,对呼吸循环影响小,术后肺部并发症少,具有较好的临床应用前景。Objective To review the application of thoracic paravertebal nerve block（TPVB） in thoracic surgery,and compare the indications and advantages and disadvantages of different paravertebral block techniques.The complications of TPVB and traditional epidural analgesia are compared. Methods Through literature review,the indications,advantages and disadvantages of TPVB such as body surface marker approach,ultrasound guidance technique,pressure measurement technique,and nerve stimulation technique were compared.Compare the complications of TPVB with conventional epidural analgesia. Results The body surface marker approach,ultrasound guidance technique,pressure measurement technique and nerve stimulation technique could safely and effectively achieve the TPVB.And the TPVB guided by ultrasound in various approaches was the most simple,with highest success rate and lowest complication rate.The effect of TPVB was comparable to epidural analgesia,and the incidence of complications such as hypotension, respiratory depression,urinary retention,incomplete block,or failure of block was lower. Conclusion TPVB guided by ultrasound is easy to operate,with high success rate and fewer puncture complications.The effect of analgesia in the perioperative period of thoracic and upper abdominal surgery is definite,it has little effect on respiratory circulation,and there are few postoperative pulmonary complications,which has a good clinical application prospect.

关 键 词：胸椎旁神经阻滞术 超声引导 神经刺激 手术 

分 类 号：R614.3[医药卫生—麻醉学]