超声引导下椎旁神经阻滞与竖脊肌平面阻滞应用于胸腔镜肺叶切除术中的效果对比  

Ultrasound-guided Thoracic Paravertebral Nerve Block and Erector Spine Plane Block in Thoracoscopic Lobectomy

作　　者：闫志兵[1] 王远胜[1] 林华赋[1] 区浩林 YAN Zhibing;WANG Yuansheng;LIN Huafu;OU Haolin(Jiangmen Central Hospital,Jiangmen 529000,China)

机构地区：[1]广东省江门市中心医院,广东江门529000

出　　处：《中国医学创新》2020年第9期19-23,共5页Medical Innovation of China

基　　金：广东省江门市医疗卫生领域科技计划项目(2017A2029)。

摘　　要：目的:比较超声引导下椎旁神经阻滞(TPVB)与竖脊肌平面阻滞(ESP)应用于胸腔镜肺叶切除术(TL)中的效果。方法:选取2018年6月-2019年8月本院68例行TL患者,按随机数字表法分为T组和E组,每组34例。T组给予超声引导下TPVB镇痛,E组给予超声引导下ESP镇痛。比较两组术后第1、12、18、24小时静息与咳嗽时的疼痛及镇静情况。比较两组术后24 h内镇痛泵按压次数、下床例数和不良反应发生情况。结果:术后第1、12小时,两组静息与咳嗽时视觉模拟评分(VAS)比较,差异均无统计学意义(P>0.05)。术后第18、24小时,E组静息与咳嗽时VAS评分均明显高于T组(P<0.05)。术后第1、12、18、24小时,两组Ramsay评分比较,差异均无统计学意义(P>0.05)。术后24 h内,两组镇痛泵按压次数、下床例数、皮肤瘙痒、恶心及呕吐发生率比较,差异均无统计学意义(P>0.05)。结论:与ESP相比,TPVB可以有效缓解患者TL术后静息与咳嗽时疼痛。两者均具有较好的镇静作用,可减少术后镇痛泵按压次数、增加下床例数,安全性高。Objective:To compare the effect of ultrasound-guided thoracic paravertebral nerve block(TPVB)and erector spine plane block(ESP)in thoracoscopic lobectomy(TL).Method:A total of 68 TL patients in our hospital from June 2018 to August 2019 were selected.They were divided into group T and group E according to the random number table method,34 cases in each group.The group T was given ultrasound-guided TPVB analgesia,the group E was given ultrasound-guided ESP analgesia.The pain and sedation of the two groups at the 1st,12th,18th and 24th hours after the surgery during rest and coughing were compared.The number of times of analgesic pump pressing,getting out of bed cases and the occurrence of adverse reactions within 24 h after surgery were compared between the two groups.Result:At 1st and 12th hours after surgery,there were no significant differences in visual analogue scores(VAS)at rest and cough between the two groups(P>0.05).At the 18th and 24th hours after surgery,VAS scores at rest and cough in the group E were significantly higher than those in the group T(P<0.05).At 1st,12th,18th and 24th hours after surgery,there were no significant differences in Ramsay scores between the two groups(P>0.05).Within 24 h after surgery,there were no significant differences between the two groups in the number of times of analgesic pump pressing,the number of getting out of bed cases,the incidence of skin itching,nausea and vomiting(P>0.05).Conclusion:Compare with ESP,TPVB can effectively relieve the pain at rest and cough of TL patients.Both have good sedative effect,can reduce the number of postoperative analgesia pump pressure,increase the number of getting out of bed cases and have high safety.

关 键 词：超声引导 椎旁神经阻滞 竖脊肌平面阻滞 胸腔镜肺叶切除术 

分 类 号：R614[医药卫生—麻醉学]