竖脊肌阻滞和椎旁神经阻滞用于胸腔镜下肺叶切除术术后镇痛的比较  

Comparison of Erector Spinae Block and Paravertebral Nerve Block for Postoperative Analgesia after Thoracoscopic Lobectomy

作　　者：李孝争 刘美荣[1] 李国振[1] 柴秋平 赵同新[1] LI Xiao-zheng;LIU Mei-rong;LI Guo-zhen;CHAI Qiu-ping;ZHAO Tong-xin(Department of Anesthesiology,Shanxian Central Hospital,Shanxian,Shandong Province,274300 China;Department of Anesthesiology,Dongda Hospital,Shanxian,Shandong Province,274300 China)

机构地区：[1]单县中心医院麻醉科,山东单县274300 [2]单县东大医院麻醉科,山东单县274300

出　　处：《中外医疗》2019年第23期50-52,共3页China & Foreign Medical Treatment

摘　　要：目的对比超声引导下竖脊肌阻滞与椎旁神经阻滞在胸腔镜下肺叶切除术后镇痛效果差异。方法方便选择2018年2月-2019年2月期间于该院进行胸腔镜下肺叶切除术患者40例,采用随机数字表法分为两组(n=20):超声引导胸椎旁阻滞组(P组)和超声引导竖脊肌阻滞组(E组)。两组患者按分组分别行阻滞手术并置管。分别记录两组患者神经阻滞所需时间以及阻滞操作中造成的局部组织和血管损伤情况。并分别于2、4、6、24和48 h时记录患者VAS评分。同时记录患者消化道、呼吸系统及皮肤等器官不良反应。结果两组神经阻滞操作耗时相比,E组(3.8±1.9)min明显短于P组(5.1±2.1)min,差异有统计学意义(t=4.214 5,P=0.047 0),两组患者术后2、4、6、24和48 h时VAS评分比较,E组明显低于P组,各时间段两组差异有统计学意义(t=50.865 4、71.111 1、18.560 4、11.045 8、8.9109,P=0.000 0、0.000 0、0.000 1、0.002 0、0.004 9);两组补救镇痛发生情况相同,均为5%;P组发生不良反应3例,E组4例,两组不良反应发生率比较差异无统计学意义(χ^2=3.243 243,P=0.071 7)。两组患者均未发生严重的局部组织、血管损伤。结论对于胸腔镜下肺叶切除术患者,应用超声引导竖脊肌阻滞镇痛效果更优,值得临床推广应用。Objective To compare the analgesic effect of ultrasound-guided erector spinae block and paravertebral nerve block after thoracoscopic lobectomy.Methods Forty patients undergoing thoracoscopic lobectomy in our hospital from February 2018 to February 2019 were convenient randomly divided into two groups (n=20): ultrasound-guided thoracic paravertebral block (group P) and ultrasound-guided erector spinae block group (group E).The two groups of patients underwent block surgery and catheterization.The time required for nerve block in both groups and the local tissue and vascular damage caused by the block operation were recorded separately.Patient VAS scores were recorded at 2,4,6,24,and 48 h,respectively.At the same time,the patient's digestive tract,respiratory system and skin and other adverse reactions were recorded.Results Compared with the time-consuming operation of the two groups,the group E (3.8±1.9) min was significantly shorter than the group P (5.1±2.1) min,and the difference was statistically significant (t=4.214 5 P=0.047 0).The VAS scores at 2,4,6,24,and 48 h after surgery were significantly lower in group E than in group P.The differences between the two groups were statistically significant(t=50.865 4,71.111 1,18.560 4,11.045 8,8.910 9,P=0.000 0,0.000 0,0.000 1,0.002 0,0.004 9);the two groups had the same remedy for analgesia,both were 5%;3 patients had adverse reactions in group P,and 4 patients in group E.There was no statistically significant difference in the incidence of adverse reactions between the two groups(χ^2=3.2432 43,P=0.071 7).No serious local tissue or vascular injury occurred in either group.Conclusion For patients undergoing thoracoscopic lobectomy,the effect of ultrasound-guided erector spinae block is better,which is worthy of clinical application.

关 键 词：竖脊肌阻滞 椎旁神经阻滞 肺叶切除术 镇痛 

分 类 号：R614[医药卫生—麻醉学]