胸椎旁神经阻滞复合全身麻醉对胸腔镜下肺叶切除术患者苏醒质量及镇痛效果的影响  

Effect of thoracic paravertebral nerve block combined with general anesthesia on quality of recovery and analgesic effect of patients undergoing thoracoscopic lobectomy

作　　者：黄修海 董桃花 邱清华 HUANG Xiuhai;DONG Taohua;QIU Qinghua(Department of Anesthesiology,the Third People's Hospital of Jiujiang,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市第三人民医院麻醉科,江西九江332000

出　　处：《当代医学》2022年第28期153-156,共4页Contemporary Medicine

摘　　要：目的探讨胸椎旁神经阻滞(TPVB)复合全身麻醉对胸腔镜下肺叶切除术患者苏醒质量及镇痛效果的影响。方法选取2014年4月至2017年4月于本院行胸腔镜下肺叶切除术的70例患者作为研究对象,按麻醉方式不同分为实验组(n=41)和对照组(n=29)。实验组行TPVB复合全身麻醉,对照组行静脉滴注及吸入复合全身麻醉,比较两组苏醒时间、苏醒质量及术后镇痛效果。结果两组呼唤睁眼时间比较差异无统计学意义;实验组完全自主呼吸时间、拔管时间、定向力恢复时间及准确回答问题时间均短于对照组,且苏醒期躁动发生率、Riker镇静躁动评分(SAS)均低于对照组,差异有统计学意义(P<0.05)。两组VAS评分组间、时间、交互比较差异有统计学意义(P<0.05)。术后1、6、12 h,实验组静息时、咳嗽时VAS评分均低于对照组,差异有统计学意义(P<0.05);术后24、48 h,实验组静息时、咳嗽时VAS评分均低于对照组,但差异无统计学意义。结论TPVB复合全身麻醉苏醒质量高,镇痛效果明显,安全性高,值得临床推广应用。Objective To investigate the effect of thoracic paravertebral nerve block(TPVB)combined with general anesthesia on the quality of recovery and analgesic effect in patients undergoing thoracoscopic lobectomy.Methods A total of 70 patients who underwent thoracoscopic lobectomy in our hospital from April 2014 to April 2017 were selected as the research subjects,and they were divided into experimental group(n=41)and control group(n=29)according to different anesthesia methods.The experimental group received TPVB combined general anesthesia,and the control group received intravenous drip and inhalation combined general anesthesia,and the awakening time,awakening quality and postoperative analgesia effect were compared between the two groups.Results There was no significant difference in the time of calling for eye opening between the two groups;the complete spontaneous breathing time,extubation time,directional recovery time and accurate answer of questions time in the experimental group were shorter than those in the control group,and the incidence of agitation during the awakening period,the Ricker sedative agitation score(SAS)were all lower than those in the control group,and the differences were statistically significant(P<0.05).There were significant differences in VAS scores between the two groups in inter-group,and interactions(P<0.05).At 1,6 and 12 h after surgery,the VAS scores of the experimental group at rest and cough were lower than those in the control group,and the differences were statistically significant(P<0.05),and at 24 and 48 h after surgery,the VAS scores in the experimental group at rest and cough were lower than those in the control group,but there were no statistically significant difference.Conclusion TPVB composite general anesthesia has high quality of awakening,obvious analgesic effect and high safety,which is worthy of clinical promotion and application.

关 键 词：胸腔镜下肺叶切除术 胸椎旁神经阻滞 苏醒质量 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]