超声引导单次竖脊肌平面阻滞与椎旁神经阻滞用于手术治疗气胸患者镇痛效果的比较  

Compraison of postoperative analgesic effect between ulstrasound-guided single erector spinae plane block and single thoracic paravertebral nerve block in patients undergoing thoracoscopic lobectomy

作　　者：钟微微 夏洪莲 安佰柱[3] 师丹 徐建军[4] ZHONG Wei-wei(Clinical Medicine of Mudanjiang Medical University,Mudanjiang 157011,China)

机构地区：[1]牡丹江医学院临床学院 [2]牡丹江医学院附属红旗医院麻醉科 [3]牡丹江医学院解剖教研室,黑龙江牡丹江157011 [4]大庆油田总医院麻醉科,黑龙江大庆163000

出　　处：《牡丹江医学院学报》2020年第1期83-86,共4页Journal of Mudanjiang Medical University

基　　金：牡丹江医学院研究生创新科研一般项目(2018YJSCX-11MY);黑龙江省省属高校基本科研业务费项目(2017-KYYWF-0642)。

摘　　要：目的探讨超声引导下单次竖脊肌平面(erector spinae plane,ESP)阻滞和单次椎旁神经(paravertebral nerve block,TPVB)阻滞在胸腔镜手术对气胸患者术后镇痛效果的比较。方法择期行气胸患者60例,随机分成2组:椎旁神经阻滞(P组)、竖脊肌平面阻滞(E组),每组30例,两组患者均采用全身麻醉,术后均不采取镇痛装置。P、E两组分别于麻醉诱导前30min行超声引导下椎旁神经阻滞与竖脊肌平面阻滞,两组均给予0.5%罗哌卡因20mL,阻滞完成后30min采用冷刺激法测量感觉阻滞平面。记录两组术前神经阻滞操作时间及感觉平面阻滞持续时间;记录两组切皮前后心率及血压的差值HR、MAP;记录术后1h、3h、6h、12h、18h及24h患者静息及咳嗽VAS评分;记录术后氟比洛芬酯给药次数。结果与P组相比,E组操作时间明显缩短及术后感觉阻滞持续时间缩短,差异具有统计学意义(P<0.05)。与P组比较,E组切皮即刻与切皮前心率、血压差值显著升高,差异具有统计学意义(P<0.01);且E组术中瑞芬太尼用量增加,差异具有统计学意义(P<0.05)。组内比较,P、E两组不同时间点静息及咳嗽时VAS评分降低,差异具有统计学意义(P<0.05)。组间比较,与P组相比,E组术后6h咳嗽时VAS评分增高,差异具有统计学意义(P<0.05)。E组、P组两组术后追加氟比洛芬酯次数及术后恶心呕吐发生率,差异均无统计学意义。P组操作过程中发生2例阻滞失败。结论超声引导下单次竖脊肌平面阻滞与单次椎旁神经阻滞胸腔镜手术对气胸患者术后镇痛效果相当。然而,超声引导下椎旁神经阻滞起效快,镇痛效果明确,术后镇痛效果良好,可安全有效地用于胸腔镜下手术治疗气胸患者术后镇痛。Objective To investigate the effect of ultrasound-guided single erector spinae plane(ESP)block and paravertebral nerve block(TPVB)block on postoperative analgesia.Methods Sixty patients(42 males and 18 females,aged 22~65 years,BMI 18.4~24.9 kg/m 2,ASA grade I-II)who underwent selective thoracoscopic partial lobectomy were randomly divided into two groups:paravertebral nerve block(group P)and erector muscle plane block(group E).Each group haD30 patients.All patients in the two groups were given general anesthesia and no analgesic device was used after operation.Both groups received ultrasound-guided paravertebral nerve block and erector spine muscle plane block 30 minutes before anesthesia induction.Both groups were given 0.5%ropivacaine 20 mL.The sensory block plane was measured by cold stimulation 30 minutes after anesthesia induction.Preoperative nerve block operation time and sensory plane block duration were recorded in the two groups;HR and MAP of heart rate and blood pressure difference before and after skin incision were recorded;static and dynamic VAS scores of patients 1 h,3 h,16h,12 h,18 h and 24 h after operation were recorded;the times of administration of flurbiprofen axetil after operation were recorded.Results Compared with group P,operation time and duration of postoperative sensory block in group E were significantly shortened,with statistically significant differences(P<0.05).Compared with group P,heart rate and blood pressure of group E increased significantly immediately after skin resection and before skin resection,with statistically significant differences(P<0.01).In addition,the intraoperative remifentanil dosage in group E increased,and the difference was statistically significant(P<0.05).Intra-group comparison showed that VAS score at rest and cough at different time points in the P and E groups decreased,and the difference was statistically significant(P<0.05).Compared with the P group,VAS score increased in group E at 6h postoperatively(P<0.05).There was no statistically significant di

关 键 词：椎旁神经阻滞 竖脊肌平面阻滞 胸腔镜手术 气胸 术后镇痛 

分 类 号：R561.4[医药卫生—呼吸系统]