超声引导下胸椎旁阻滞复合全身麻醉在多发肋骨骨折内固定术中的应用效果  

Effect of ultrasound-guided thoracic paravertebral block combined with general anesthesia in internal fixation of multiple rib fractures

作　　者：赵淑芳[1] 黄中梅[1] 陈文华 张勤安[2] Zhao Shufang;Huang Zhongmei;Chen Wenhua;Zhang Qin’an(Department of Anesthesiology,Zhengzhou Sixth People’s Hospital,Zhengzhou 450000,China;Department of Orthopaedics,Zhengzhou Sixth People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省郑州市第六人民医院麻醉科,450000 [2]河南省郑州市第六人民医院骨科,450000

出　　处：《中国实用医刊》2020年第16期49-52,共4页Chinese Journal of Practical Medicine

摘　　要：目的观察超声引导下胸椎旁阻滞复合全身麻醉在多发肋骨骨折内固定术中的应用效果。方法抽取2016年11月至2019年11月郑州市第六人民医院收治的多发肋骨骨折患者60例为研究对象,按随机数表法将患者分为全身麻醉组(A组)和胸椎旁阻滞复合全身麻醉组(B组),每组30例。A组实施采用术中静吸复合全身麻醉及术后舒芬太尼静脉自控镇痛,B组实施超声引导下使用罗哌卡因胸椎旁阻滞复合全身麻醉,观察比较两种麻醉效果:两组患者术中心率、无创血压、脉搏血氧饱和度,两组患者术毕清醒时间、烦躁程度,两组患者术后不良反应发生率(包括尿潴留、恶心呕吐、瘙痒、呼吸困难、嗜睡),术后连续观察呼吸功能。结果 A、B组患者的术中心率、无创血压和脉搏血氧饱和度比较,差异未见统计学意义(P>0.05)。B组患者术毕的清醒时间少于A组;术毕30 min B组患者烦躁程度低于A组。B组患者术后不良反应发生率(包括尿潴留、恶心呕吐、瘙痒、嗜睡)低于A组,差异有统计学意义(P<0.05)。术后B组患者术后1、3 d动脉血氧分压及氧合指数高于A组,差异有统计学意义(P<0.05);B组患者术后1、3 d动脉二氧化碳分压与A组比较,差异未见统计学意义(P>0.05)。B组患者术后1、3 d后第1秒用力呼气量、用力肺活量高于A组.差异有统计学意义(P<0.05)。结论在多发肋骨骨折内固定术中实施超声引导下胸椎旁阻滞复合全身麻醉,麻醉效果良好,既能减轻患者围术期各种不良反应,也能使患者呼吸功能尽快恢复,术后疼痛减轻,加速患者术后康复。Objective To investigate the effect of ultrasound-guided thoracic paraspinal block combined general anaesthesia for internal fixation of multiple rib fractures.Methods A total of 60 patients with multiple rib fractures admitted to Zhengzhou Sixth People’s Hospital from November 2016 to November 2019 were selected as study subjects.The patients were divided into general anesthesia group(group A)and thoracic paravertebral block combined general anesthesia group(group B)according to the random number table method,with 30 patients in each group.In group A,intraoperative static inhalation combined with general anesthesia and postoperative sufentanil controlled intravenous analgesia were applied,while in group B,ultrasound-guided ropivacaine was applied with thoracic paravertebral block combined with general anesthesia.The observation and comparison of the two anesthesia effects were as follows:the operative center rate,noninvasive mean arterial blood pressure and pulse oxygen saturation of the two groups;awake time and irritability after operation of the two groups of patients;incidence of postoperative adverse reactions(including urinary retention,nausea and vomiting,itching,dyspnea and drowsiness)between the two groups;postoperative respiratory function was continuously observed.Results There were no statistically significant differences in operative center rate,noninvasive blood pressure and pulse oxygen saturation between group A and group B(P>0.05).Group B had significantly less awake time after operation than group A;30 min after operation,the degree of irritability in group B was significantly lower than that in group A.The incidence of postoperative adverse reactions(including urinary retention,nausea and vomiting,itching and drowsiness)in the two groups in group B were lower than those in group A,with statistically significant difference(P<0.05).The partial arterial oxygen pressure and oxygenation index at 1 day and 3 days after operation in group B were higher than those in group A,with statistically signi

关 键 词：超声 多发肋骨骨折 胸椎旁阻滞 疼痛 

分 类 号：R614[医药卫生—麻醉学]