超声引导单点和双点椎旁神经阻滞在胸腔镜术患者的镇痛比较  

Comparison of Analgesia in Ultrasound-guided Single-Point and Double-point Paravertebral Nerve Block for Patients undergoing Thoracoscopic Surgery

作　　者：王兴耀 钱金桥[2] WANG Xing-yao;QIAN Jing-qiao(Dept.of Anesthesiology,Kunming Medical University,Yunnan Kunming 650500;Dept.of Anesthesiology,The First Affiliated Hospital of Kunming Medical University,Yunnan Kunming 650032,China)

机构地区：[1]昆明医科大学麻醉学系,云南昆明650500 [2]昆明医科大学第一附属医院麻醉科,云南昆明650032

出　　处：《昆明医科大学学报》2020年第8期46-51,共6页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81460044,81860050)。

摘　　要：目的观察超声引导单点和双点椎旁神经阻滞在胸腔镜术患者的镇痛比较。方法选择ASA I^II级,年龄50~70岁,无心肺疾病,全麻下行胸腔镜下肺叶切除手术的患者90例。随机分为超声引导下的单点TPVB复合全麻手术组(A组)、超声引导下的双点TPVB复合全麻手术组(B组)和单纯全麻手术组(C组)三组。观察指标:(1)观察记录阻滞麻醉操作时间、麻醉阻滞平面、麻醉阻滞起效时间等;(2)观察记录患者进入手术室后(T0)、术后1 h (T1)、2 h (T2)、6 h (T3)、8 h (T4)、12 h (T5)、24 h (T6)、48 h (T7)的MAP和HR;(3)记录患者满意度;(4)记录T1、 T2、T3、T4、 T5、 T6、 T7安静及咳嗽时视觉模拟评分法(VAS)评分,静脉自控镇痛泵(PCIA)按压的总次数;(5)记录患者恶心、呕吐发生情况。结果 (1)在T1、T2、T3、T4、T5、T6 A组、B组与C组相比较,HR和MAP降低,差异有统计学意义(P<0.05)。(2)与B组相比,A组阻滞操作时间更短,差异具有统计学意义(P<0.05);阻滞平面比B组低,差异具有统计学意义(P<0.05);A组满意度更高,差异有统计学意义(P<0.05);(3)静息状态下T1、T2、T3、T4、T5、T6、T7,A组、B组与C组比较VAS评分低,差异有统计学意义(P<0.05);咳嗽状态下T1、T2、T3、T4、T5、T6、T7,A组、B组与C组比较VAS评分低,差异有统计学意义(P<0.05);(4) A组和B组比C组术后恶心、呕吐发生率更低,差异有统计学意义(P<0.05);A组和B组比C组镇痛泵按压次数更少,差异有统计学意义(P<0.05)。结论 (1)超声引导下的TPVB用于胸腔镜手术,可以有效减轻患者术后疼痛,减少静脉镇痛药物的使用,恶心、呕吐反应少,有利于患者术后康复;(2)超声引导下的单点TPVB在术后镇痛作用、减少静脉镇痛药物的使用以及减轻术后恶心、呕吐反应方面基本等同于双点。但是,单点TPVB较双点TPVB操作时间短,患者满意度更高。Objective To observe the analgesic effect of ultrasound-guided single-point and double-point paravertebral nerve block in patients undergoing thoracoscopic surgery. Methods Ninety ASA I-II patients were chosen if they were: aged 50-70 years, with no cardiopulmonary disease,and undergoing thoracoscopic lobectomy under general anesthesia. They were randomly divided into three groups: ultrasound-guided single-point TPVB combined with general anesthesia group(group A), ultrasound-guided double-point TPVB combined with general anesthesia group(group B) and simple general anesthesia operation group(group C). The following indicators were observed and recorded:(1) the time of anesthesia operation, the range of anesthesia block plane and the onset time of anesthesia block;(2) MAP and HR after entering the operating room(T0), 1 h(T1), 2 h(T2),6 h(T3), 8 h(T4), 12 h(T5), 24 h(T6), 48 h(T7);(3) patient’s satisfaction;(4) visual analogue scoring(VAS) scores at 1, 2, 6, 8, 12, 24, 48 h after operation and cough,and the total number of patient controlled intravenous analgesia pump(PCIA) compressions in all patients;(5) the occurrence of nausea and vomiting in patients. Results(1). Compared with group C at T1, T2, T3, T4, T5 and T6, HR and MAP in group A and B decreased significantly(P < 0.05).(2) Compared with group B, block operation time in group A was shorter, with statistical significance(P < 0.05). The block plane of group A was lower than that of group B, with statistical significance(P < 0.05). The satisfaction of group A was higher, with statistical significance(P <0.05).(3) Compared with group C, in resting state, the VAS scores of T1, T2, T3, T4, T5, T6 and T7 were lower than those of group A and B(P < 0.05);in cough state, the VAS scores of group A and B at T2,T3, T4, T5, T6 and T7 were lower than those of group C(P < 0.05).(4) The incidence of postoperative nausea and vomiting in group A and group B was lower than that in group C,(P < 0.05), the number of pressing of analgesic pump was lower in group A and group

关 键 词：超声引导 单点和多点 胸椎旁神经阻滞 胸腔镜手术 术后镇痛 

分 类 号：R614.2[医药卫生—麻醉学]