胸腔镜下胸椎旁神经阻滞对肺癌术后镇痛效果临床观察  

Clinical observation of analgesic effect by thoracoscopic thoracic paravertebral nerve block after lung cancer surgery

作　　者：李宝鹏 胡德宏[2] 李伟[2] LI Baopeng;HU Dehong;LI Wei(Department of Surgery,Weifang Medical University,Weifang 261053,China;Department of Thoracic Surgery,Weifang People's Hospital)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊市人民医院胸外科

出　　处：《潍坊医学院学报》2019年第6期464-466,共3页Acta Academiae Medicinae Weifang

摘　　要：目的观察胸腔镜下胸椎旁神经阻滞与肋间神经阻滞对肺癌术后镇痛效果。方法选取2018年7月~2019年6月本院收治的100例非小细胞肺癌胸腔镜手术患者,按照手术时间先后分为两组,分别给予不同镇痛方式。前50例为观察组,给予术中胸腔镜下胸椎旁神经阻滞(TPVB)。后50例为对照组,给予肋间神经阻滞(INB)。对所有患者进行术后48h床旁随访,记录观察临床预后指标,包括术后VAS疼痛评分、额外应用止痛药物次数、胸腔引流管留置时间等。结果术后6,12,24,48h,观察组患者VAS疼痛评分均低于同期对照组,差异有显著性(P<0.05);术后48h内,观察组病房追加应用止痛药物次数少于对照组,差异有显著性(P<0.05);术后观察组患者胸腔引流管留置时间少于对照组,差异有显著性(P<0.05)。结论相较于肋间神经阻滞,胸腔镜下胸椎旁神经阻滞镇痛效果更为理想,并且可缩短胸腔引流管留置时间,顺应加速康复外科(ERAS)的理念,值得临床推广应用。Objective To observe the postoperative analgesia effect by thoracic parasternal nerve block and intercostal nerve block on lung cancer.Methods One hundred patients who underwent thoracoscopic operation in our hospital from July 2018 to June 2019 were enrolled and divided into two groups according to the operation time,given different analgesia methods.The first 50 cases as observation group were given intraoperative thoracoscopic paraplebral nerve block(TPVB).The latter 50 cases as control group were given intercostal nerve block(INB).All patients were followed up 48 hours after the operation,and the clinical prognosis was recorded,including the VAS pain score,the number of additional pain medication and the retention time of the chest drainage tube.Results At the 6 th,12 th,24 th and 48 th hour after operation,the VAS scores of the patients in the observation group were lower than those in the control group.The difference was statistically significant(P<0.05).During the 48 hours after the surgery,the frequency using of additional analgesic drugs were less than the control group,which has statistically significance(P<0.05).The retention time of chest tube in the observation group was significantly less than the control group(P<0.05).Conclusion Compared with intercostal nerve block,thoracoscopic thoracic paravertebral nerve block has better analgesic effect,shorter retention time for chest tube,and is worthy clinical application.

关 键 词：非小细胞肺肿瘤 术后疼痛 胸腔镜下胸椎旁神经阻滞 加速康复外科 

分 类 号：R734.2[医药卫生—肿瘤]