全麻复合超声引导下单次胸椎旁阻滞对单孔胸腔镜手术患者术后疼痛和快速康复的影响  

Effects of single thoracic paravertebral block guided by general anesthesia combined with ultrasound on postoperative pain and rapid recovery in patients undergoing single-port thoracoscopic surgery

作　　者：张婵娟[1] 黄理进[1] 陈海林[1] 莫朴[1] 利鸿胜[1] ZHANG Chanjuan;HUANG Lijin;CHEN Hailin;MO Po;LI Hongsheng(Department of Anesthesiology,Maoming People＇s Hospital,Guangdong Province,Maoming 525000,China)

机构地区：[1]广东省茂名市人民医院麻醉科,广东茂名525000

出　　处：《中国医药科学》2018年第17期153-156,共4页China Medicine And Pharmacy

摘　　要：目的探索全麻复合超声引导下单次胸椎旁阻滞对单孔胸腔镜手术(VATS)患者术后疼痛和快速康复的影响。方法选择2016年8月～2017年8月期间择期行单孔VATS手术的44例患者为研究对象,并采用随机、单盲法将其分为两组,各22例,其中对照组患者采用单纯全凭静脉麻醉,观察组患者于麻醉诱导前应用超声引导下单次椎旁神经阻滞。测量术前1d及术后4、8、12、24h时患者机械痛阈值;记录患者术后第1次疼痛反馈时间,术后24h地佐辛用量、术后第1次下床活动时间、患者住院时间并进行组间比较。结果两组术后的机械痛阈值随着术后时间的延长逐渐下降,两组时间点间的差异有统计学意义(F=4.237,P=0.019);且在术后4、8、12h的机械痛阈值之间比较差异有统计学意义(t=-53.889,-47.632,-2.850,P <0.05)。观察组患者术后第1次疼痛反馈时间(12.81±1.30)h与对照组比较明显增加(t=7.43,P <0.05),而术后24h地佐辛用量(6.02±0.77)mg、术后第1次下床活动时间(1.51±0.13)d、平均住院时间(5.22±0.66)d与对照组比较明显减少,组间差异均有统计学意义(t=7.432,6.801,6.322,7.101,P <0.05)。结论全麻复合超声引导下单次胸椎旁阻滞可减轻VATS手术患者术后切口疼痛,减少24h内阿片类药物的用量,且有利于患者术后早期活动,为临床应用提供更好的选择。Objective To explore the effect of single parathoracic block guided by general anesthesia combined with ultrasound on postoperative pain and rapid recovery in patients undergoing single-hole thoracoscopic surgery. Methods From August 2016 to August 2017,44 patients who were scheduled to undergo single-port VATS surgery were selected as the study subjects and divided into two groups by random and single blind method,with 22 cases each.The control group was treated with total intravenous anesthesia,while the observation group was treated with single paravertebral nerve block guided by ultrasound before anesthesia induction.Mechanical pain threshold was measured before 1d and at 4,8,12 and 24h after operation.The first pain feedback time,the dosage of dezocine 24 hours after operation,the first ambulation time after operation and the hospitalization time of patients were recorded and compared between groups. Results The mechanical pain threshold of the two groups decreased gradually with the prolongation of postoperative time,and the difference between the two groups was statistically significant （F=4.237,P=0.019）.There were significant differences in the mechanical pain thresholds between 4,8 and 12 hours after operation （t= -53.889,-47.632,-2.850,P 〈0.05）.The first postoperative pain feedback time（12.81±1.30）h of the observation group was significantly longer than that of the control group （t=7.43,P 〈0.05）,while the dosage of dezocine 24 hours after operation （6.02±0.77）mg,the first postoperative ambulation time （1.51±0.13）d and the average hospitalization time （5.22±0.66）d were significantly shorter than those of the control group,there was statistical significance （t=7.432,6.801,6.322,7.101,P 〈0.05）.Conclusion Single thoracic paravertebral block guided by general anesthesia combined with ultrasound can alleviate postoperative incision pain of patients undergoing VATS surgery,reduce the use of opioids within 24 hours,facilitate early postoperative activities of patients,a

关 键 词：单次胸椎旁阻滞 单孔腹腔镜 疼痛 康复 

分 类 号：R614[医药卫生—麻醉学]