不同胸椎旁神经阻滞方式在胸腔镜肺叶切除术围术期镇痛效果比较  

Comparison on preoperatively analgesic efficacy between two different thoracic paravertebral block methods for lobectomy via video-assisted thoracoscopic surgery

作　　者：罗太君 高广阔[1] 李坤 刘伟[1] LUO Tai-jun;GAO Guang-kuo;LI Kun;LIU Wei(Department of Anesthesiology,Beijing Chest Hospital Affiliated to Capital Medical University,Beijing 101149,China)

机构地区：[1]北京市结核病胸部肿瘤研究所首都医科大学附属北京胸科医院麻醉科

出　　处：《临床肺科杂志》2019年第7期1188-1192,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的评价术前单次椎旁阻滞(thoracic paravertebral block,TPVB)复合静脉镇痛和术前椎旁置管连续阻滞对胸腔镜肺叶切除术(video-assisted thoracic surgery,VATS)患者围术期镇痛效果。方法纳入2018年4月至2018年8月在北京胸科医院行胸腔镜单一肺叶切除的肺癌患者99例,随机分为单次双点椎旁注射组(G1组,33例)、椎旁置管组(G2组,33例)和对照组(G0组,33例)。G0组术后采用静脉自控镇痛;G1组诱导前在超声引导下行单次双点TPVB,术后采用静脉自控镇痛;G2组诱导前在超声引导下椎旁置管,术后镇痛采用连续TPVB。随访记录3组患者术后1h、术后4h、术后24h和术后48h的视觉模拟疼痛评分(visual analogue score,VAS)、按压次数、镇静评分和镇痛补救次数;记录术中舒芬太尼、七氟烷和丙泊酚用量;记录苏醒时间、拔管时间;记录恶心、呕吐和苏醒期躁动等不良反应。结果与G0组相比:G1组和G2组在上述随访时刻静息时和咳嗽时的VAS评分明显降低(P<0.05),术中舒芬太尼、七氟烷用量明显减少(P<0.05),苏醒时间发生明显缩短(P<0.05),上述指标在G1组和G2组却没有明显差异(P>0.05);与G0组和G1组相比,G2组总不良反应发生率较低(P<0.05)。结论术前单次双点TPVB复合静脉镇痛和术前椎旁置管连续TPVB均能有效缓解VATS术后急性疼痛,但连续TPVB具有较低的不良反应发生率,更推荐其为VATS围术期镇痛首选方案。Objective To compare the preoperatively analgesic efficacy between double-level thoracic paravertebral block(TPVB)and continuous thoracic paravertebral block for lobectomy via video-assisted thoracoscopic surgery.Methods 99 patients were randomly divided into the double-level TPVB group(the group G1,n=33),the continuous TPVB(the group G2,n=33)and the control group(the group G0,n=33).The group G0 was given only PCIA postoperatively,the group G1 was given ultrasound-guided double-level TPVB preoperatively and PCIA postoperatively,and the group G2 was given a 20 G thoracic catheter insertion in the paravertebral space via ultrasound guide preoperatively and continuous TPVB postoperatively.The primary outcome was the visual analog scale(VAS)at rest and coughing in 1 hour,4 hours,24 hours and 48 hours after surgery.Secondary outcomes included,emergence time,extubation time,the consumption of general anesthetics,sedation score(Ramsay),PCA demand times and adverse events postoperatively.Results Compared with the group G0,there were lower pain intensity scores at rest or on cough at each time point in the group G1 and the group G2(P<0.05).The emergence time,and the consumption of sufentanil and sevoflurane in the group G1 and the group G2 were significantly less than those in the group G0(P<0.05),while there was no significant difference between the group G1 and the group G2(P>0.05).The total incidence of adverse events in the group G2 was lower that in the group G0 and the group G1(P<0.05).Conclusion Both preoperatively double-level TPVB combined with PCIA and continuous TPVB are effective and safe methods to relieve acute pain after VATS,but the former has less adverse events as a preoperative analgesia regimen.

关 键 词：椎旁阻滞 胸腔镜手术 围术期镇痛 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]