超声引导下后路椎板阻滞与椎旁阻滞对胸腔镜肺叶切除术镇痛效果的比较  

Analgesic efficacy of ultrasound-guidance retrolaminal block versus paravertebral block for video-assisted thoracoscopic lobectomy

作　　者：李宗超 张云霄[2] 谭宏宇[2] 张艳 王保国[1] LI Zongchao;ZHANG Yunxiao;TAN Hongyu;ZHANG Yan;WANG Baoguo(Department of Anesthesiology,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Department of Anesthesiology,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]首都医科大学三博脑科医院麻醉科,北京100093 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所麻醉科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国疼痛医学杂志》2021年第12期917-922,共6页Chinese Journal of Pain Medicine

摘　　要：目的:比较超声引导下后路椎板阻滞(retrolaminal block,RLB)和椎旁阻滞(paravertebral block,PVB)用于胸腔镜肺叶切除术术中及术后的镇痛效果。方法:拟行胸腔镜肺叶切除术病人84例,按随机数字表法分为:后路椎板阻滞组(RLB组)、椎旁阻滞组(PVB组)和对照组(C组),每组28例。RLB组与PVB组分别于全身麻醉诱导前在超声引导下行单次术侧神经阻滞(RLB组引导穿刺针至椎板后表面,PVB组引导穿刺针进入椎旁间隙),两组均单次注入0.5%的罗哌卡因20 ml,C组不予阻滞。三组病人全身麻醉方法相同,术毕均连接经静脉病人自控镇痛泵(patient controlled intravenous analgesia,PCIA)。记录三组病人入室后、切皮前、切皮后1 min和5 min的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)的变化、术中低血压发生率及去氧肾上腺素、瑞芬太尼用量;采用疼痛数字评分法(numerical rating scale,NRS)评分记录三组术后2 h、8 h、12 h、24 h和48 h静息状态疼痛评分;记录术后48 h内PCIA有效按压次数、补救镇痛情况及恶心呕吐、感染、局部麻醉药中毒和穿刺损伤等不良反应发生情况。结果:纳入病人84例,最终76例完成研究(RLB组25例,PVB组25例,C组26例)。RLB组与PVB组切皮后1 min和5 min的MAP和HR、术中瑞芬太尼用量、术后48 h内PCIA有效按压次数、补救镇痛率及术后静息状态2 h、8 h、12 h、24 h的NRS评分均显著低于C组(P<0.05),RLB组与PVB组比较差异无统计学意义。与PVB组相比,RLB组术中低血压发生率较少(32%vs.76%),去氧肾上腺素使用量明显减少[0(0-0.9)μg/kg vs.2.6(1.2-3.3)μg/kg]。三组术后恶心呕吐发生率差异无统计学意义;RLB组与PVB组均未出现感染、局部麻醉药中毒、穿刺损伤等不良反应。结论:超声引导下单次RLB和PVB联合全身麻醉均可降低胸腔镜肺叶切除术切皮反应,减少术中阿片类药物用量并能够提供有效的术后镇痛,RLB组术中血流动力Objective:To compare the analgesic efficacy of ultrasound-guided retrolaminal block(RLB)or paravertebral block(PVB)in patients undergoing video-assisted thoracoscopic lobectomy.Methods:Eighty-four patients scheduled for video-assisted thoracoscopic lobectomy were randomly divided into three groups:group RLB,group PVB and control group(group C)(n=28 in each group).Patients in group RLB and group PVB underwent single ultrasound-guided nerve block before general anesthesia,with 20 ml of 0.5% ropivacaine injected into the surface of laminar in group RLB or the paravertebral space in group PVB,while no nerve block in group C.All groups adopted the same method for general anesthesia.Patient controlled intravenous analgesia(PCIA)was applied in all patients after operation.Mean arterial pressure(MAP)and heart rate(HR)were monitored after the patients entered operating room,before skin incision and at 1 min,5 min after skin incision.Incidence of hypotension,consumption of phenyl-ephrine and remifentanil,and resting numerical rating scale(NRS)scores at 2 h,8 h,12 h,24 h and 48 h after oper-ation were recorded.The number of effective compressions of PCIA within 48 h,the needs for rescue analgesia and adverse reactions were recorded too.Results:A total of 84 patients were recruited and 76 patients were eventually enrolled in the study,25 patients in group RLB,25 patients in group PVB and 26 patients in group C.Compared with group C,both group RLB and group PVB had a significant decrease in MAP and HR at 1 min and 5 min after skin incision,as well as the consumption of remifentanil,the number of effective compressions of PCIA,the rate of rescue analgesia,and the resting NRS scores at 2 h,8 h,12 h and 24 h after surgery(P<0.05),but there was no significant difference between the block groups.Compared with group PVB,the group RLB had a prominent decrease(32%vs.76%)in the incidence of hypotension and consumption of phenylephrine[0(0-0.9)μg/kg vs.2.6(1.2-3.3)μg/kg].There was no significant difference in the incidence of nausea

关 键 词：超声引导 后路椎板阻滞 椎旁阻滞 胸腔镜肺叶切除术 

分 类 号：R614[医药卫生—麻醉学]