胸椎旁神经阻滞用于腹腔镜下肾切除术的镇痛效果评价  

Analgesic efficacy of thoracic paravertebral block in laparoscopic nephrectomy

作　　者：杨鹤[1] 郑莉[1] 李修良[1] 刘庆鑫 薛富善 YANG He;ZHENG Li;LI Xiuliang;LIU Qingxin;XUE Fushan(Department of Anesthesiology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《中华实用诊断与治疗杂志》2020年第7期674-677,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金面上项目(81470019)。

摘　　要：目的探讨腹腔镜下肾切除术中应用胸椎旁神经阻滞(thoracic paravertebral block,TPVB)镇痛的效果和安全性。方法行单侧腹腔镜下肾切除术患者40例,随机分为观察组和对照组各20例。观察组术中采用TPVB,对照组术中未采用TPVB。记录2组麻醉前(T0)、手术开始时(T1)、手术15 min(T2)、手术1 h(T3)、手术结束时(T4)和术后6 h(T5)的心率和平均动脉压(mean arterial pressure,MAP);分别于术后清醒即刻及术后1、6、12、24、48、72 h行静止、活动时的视觉模拟评分(visual analogue scale,VAS);比较术中麻醉药物异丙酚、瑞芬太尼使用量;比较术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)按压次数和舒芬太尼使用量以及拔管时间、出室时间、术后不良反应。结果观察组T1~T5时MAP较对照组低,心率较对照组慢(P<0.05)。观察组术后1、6、12、24、48、72 h静止VAS(1.9±0.6、2.0±0.6、1.8±0.5、1.8±0.4、1.7±0.6、1.4±0.5)和活动VAS(3.1±0.6、3.3±0.5、3.5±0.5、2.9±0.6、2.6±0.7、1.8±0.5)均低于对照组(静止VAS:3.8±0.7、4.1±0.7、3.8±0.7、3.3±0.6、2.6±0.6、1.8±0.4;活动VAS:4.9±0.7、4.9±0.6、5.1±0.6、4.4±0.6、3.3±0.7、2.3±0.6)(P<0.05)。观察组术后PCIA按压次数[(11.6±2.7)次]、舒芬太尼使用量[(22.9±5.2)μg]较对照组[(35.3±4.7)次、(70.6±16.4)μg]少,术后拔管时间[(5.6±1.6)min]、出室时间[(10.6±2.5)min]较对照组[(8.7±2.0)、(14.6±2.5)min]短(P<0.05)。2组均未出现术后谵妄、躁动等严重麻醉不良事件。结论TPVB用于腹腔镜下肾切除术具有良好的镇痛效果和安全性。Objective To evaluate the analgesic efficacy and safety of thoracic paravertebral block(TPVB)in laparoscopic nephrectomy.Methods Forty patients undergoing laparoscopic nephrectomy were equally and randomly divided into TPVB group and non-TPVB group.The heart rate and mean arterial pressure(MAP)were recorded before anesthesia(T0),at the beginning of operation(T1),in 15 min after the beginning of operation(T2),in 60 min after the beginning of operation(T3),at the end of operation(T4),and in 6 h after operation(T5).The pain intensities at rest and activity based on visual analogue scale(VAS)were recorded immediately after recovery from general anesthesia,and in 1,6,24,48 and 72 h after operation.The cumulative dose of propofol and remifentanil during operation,the frequency of patient controlled intravenous analgesia(PCIA)attempts and consumption dose of sulfentanil after operation,the time of extubation,the time of leaving operating room and adverse reactions were also recorded.Results The MAP was lower and heart rate was slower at T1-T5 in TPVB group than that in non-TPVB group(P<0.05).The VAS scores at rest(1.9±0.6,2.0±0.6,1.8±0.5,1.8±0.4,1.7±0.6,1.4±0.5)and activity(3.1±0.6,3.3±0.5,3.5±0.5,2.9±0.6,2.6±0.7,1.8±0.5)in 1,6,24,48 and 72 h after operation in TPVB group were significantly lower than those in non-TPVB group(at rest:3.8±0.7,4.1±0.7,3.8±0.7,3.3±0.6,2.6±0.6,1.8±0.4;at activity:4.9±0.7,4.9±0.6,5.1±0.6,4.4±0.6,3.3±0.7,2.3±0.6)(P<0.05).The frequency of PCIA attempts and consumption dose of sulfentanil after operation were significantly lower in TPVB group(11.6±2.7,(22.9±5.2)μg)than those in non-TPVB group(35.3±4.7,(70.6±16.4)μg),and the time of extubation and the time of leaving operating room were shorter in TPVB group((5.6±1.6),(10.6±2.5)min)than those in non-TPVB group((8.7±2.0),(14.6±2.5)min)(P<0.05).No deliration,dysphoria or other anesthetic adverse reaction was found in two groups.Conclusion TPVB provides a good analgesic effect and safety in laparoscopic nephrectomy.

关 键 词：胸椎旁神经阻滞 腹腔镜下肾切除术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]