低浓度布比卡因复合地塞米松胸腔镜直视下椎旁阻滞在肺癌术后镇痛的效果  

Paravertebral block under thoracoscopy with low concentration bupivacaine combined with dexamethasone in postoperative patients with lung cancer

作　　者：樊虹 周志强 嵇晴 FAN Hong;ZHOU Zhi-qiang;JI Qing(Department of Anesthesiology,Affiliated Jinling Hospital of Medical School of Nanjing University,Nanjing,Jiangsu 210002,China)

机构地区：[1]南京大学医学院附属金陵医院麻醉科,江苏南京210002

出　　处：《中国临床研究》2021年第6期777-780,786,共5页Chinese Journal of Clinical Research

摘　　要：目的探讨低浓度布比卡因复合地塞米松用于胸腔镜直视下椎旁阻滞在肺癌患者肺叶切除术后镇痛的有效性和安全性。方法回顾性分析2017年11月至2019年1月金陵医院收治的ASAⅠⅡ级、择期行胸腔镜下肺叶切除术患者90例的临床资料,根据术后镇痛方案的不同分为A、B、C组,每组30例。A、B组患者在关胸前由同一术者行椎旁阻滞,A组患者注射0.13%布比卡因负荷量15 ml后接0.13%布比卡因镇痛泵术后持续镇痛;B组患者注射0.13%布比卡因+地塞米松混合液负荷量15 ml后接0.13%布比卡因和地塞米松混合液的镇痛泵术后持续镇痛;C组采用静脉自控镇痛。观察各组术后6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))、72 h(T_(5))的静息和活动后疼痛视觉模拟评分(VAS),并发症的发生率,镇痛药物的追加例数和临床预后指标。结果B组患者在T_(1)、T_(3)时的静息VAS评分显著低于A组(P<0.05),在T_(1)T_(5)时的静息VAS评分显著低于C组(P<0.05);A组患者在T_(5)时静息VAS评分显著低于C组(P<0.05);B组患者在T_(1)、T_(2)、T_(3)、T_(5)时的活动后VAS评分显著低于A组(P<0.05),在T_(1)T_(5)时的活动后VAS评分显著低于C组(P<0.05);A组在T_(5)时的活动后VAS评分显著低于C组(P<0.05)。3组术后哌替啶使用率对比差异无统计学意义(P>0.05)。A组、B组术后恶心、呕吐、嗜睡等并发症总发生率分别为6.67%和0,C组高达53.33%,3组间差异有统计学意义(P<0.01)。A组、B组均未出现局麻药中毒、血气胸和肺部并发症。A组、B组首次下床活动时间、胸腔引流管留置时间和术后住院时间显著短于C组(P<0.05),A组、B组间比较差异无统计学意义(P>0.05)。结论肺癌患者胸腔镜下行肺叶切除采用低浓度布比卡因和低浓度布比卡因复合地塞米松椎旁阻滞术后镇痛均是安全有效的,其中0.13%布比卡因复合地塞米松椎旁阻滞与静脉自控镇痛相比,有更好的镇痛效果和更少的�Objective To explore the efficacy and safety of paravertebral block in thoracoscopic pulmonary lobectomy with low concentration bupivacaine combined with dexamethasone in patients with lung cancer.Methods A retrospective analysis was performed in 90 ASA(American Society of Anesthesiologists)ⅠandⅡpatients scheduled for thoracoscopic lobectomy in the Jinling Hospital from November 2017 to January 2019.The patients were divided into group A,group B and group C according to different postoperative analgesia methods(n=30,each).Before chest closure,a loading dose of 0.13%bupivacaine 15 ml was injected and followed by 0.13%bupivacaine analgesia pump for continuous postoperative analgesia in group A.A loading dose of 15 ml bupivacaine(0.13%)and dexamethasone mixture was given and maintained by analgesia pump for continuous postoperative analgesia in group B.Patient-controlled intravenous analgesia(PCIA)was conducted in group C.At 6-(T_(1)),12-(T_(2)),24-(T_(3)),48-(T_(4))and 72-h(T_(5))after operation,the degree of pain at rest and on activity by visual analogue scale(VAS),the incidence of complications,the number of patients needing additional analgesics and prognostic indexes were observed.Results VAS scores in group B were significantly lower than those in group A at T_(1)and T_(3)(P<0.05),VAS scores in group B were significantly lower than those in group C at T_(1)and T_(5)(P<0.05),and VAS score in group A was significantly lower than that in group C at T_(5)(P<0.05).VAS scores in group B were significantly lower than those in group A at T_(1),T_(2),T_(3)and T_(5)(P<0.05)and were significantly lower than those in group C at T_(1)and T_(5),and VAS score in group A was significantly lower than that in group C at T_(5)(all P<0.05).There was no significant difference in postoperative utilization rate of pethidine among three groups(P>0.05).The total incidence of postoperative nausea,vomiting,sleepiness and other complications in group A and group B was 6.67%and 0 respectively,and 53.33%in group C,the difference betwe

关 键 词：胸腔镜 椎旁阻滞 布比卡因 低浓度 地塞米松 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]