髂肋肌平面阻滞与胸椎旁阻滞用于胸腔镜术后镇痛的效果比较  

Comparison of Iliocostalis Plane Block and Thoracic Paravertebral Block for the Effect of Postoperative Analgesia after Thoracoscopic Surgery

作　　者：张隆盛[1] 李春然 杨铎 林耿彬[1] 张欢楷[1] 林旭林 Zhang Longsheng(Jieyang People’s Hospital,Jieyang Guangdong 522000)

机构地区：[1]揭阳市人民医院,广东揭阳522000

出　　处：《黑龙江医药》2023年第4期750-754,共5页Heilongjiang Medicine journal

基　　金：广东省医学科学技术研究基金(编号:A2021400)。

摘　　要：目的:本研究旨在探讨髂肋肌平面阻滞与胸椎旁阻滞用于胸腔镜术后镇痛的效果比较。方法:选择2020年9月至2023年3月在我院收治的需要择期胸腔镜手术患者60例,采用随机数字表法将研究对象分为胸椎旁阻滞组(T组)和髂肋肌平面阻滞组(I组),每组30例。T组在麻醉诱导前实施胸椎旁阻滞,I组在麻醉诱导前实施髂肋肌平面阻滞,两组患者均使用健侧支气管插管全凭静脉麻醉,术后行静脉自控镇痛。记录两组患者超声定位时间、穿刺时间、一次穿刺成功率;记录两组患者术后2h、8h、12h、24h、48h的静息和运动疼痛VAS评分;记录两组患者术后首次按压镇痛泵时间、术后48h内镇痛泵按压次数;记录两组患者术后48h不良反应发生情况,包括穿刺部位感染、血肿、恶心呕吐、眩晕等。结果:与T组患者比较,I组患者超声定位时间、穿刺时间明显缩短(P<0.05),一次穿刺成功率明显升高(P<0.05),两组患者术后不同时点静息和运动疼痛VAS评分差异均无统计学意义(P>0.05),两组患者术后首次按压PCA时间、术后48h内镇痛泵有效按压次数均无统计学意义(P>0.05),两组患者术后48h均未发生穿刺部位感染、血肿、恶心呕吐、眩晕等不良反应。结论:髂肋肌平面阻滞或胸椎旁阻滞联合静脉镇痛用于胸腔镜术后镇痛,两种多模式镇痛效果相当,但髂肋肌平面阻滞超声定位和穿刺时间更短,一次穿刺成功率更高。Objective:The purpose of this study was to compare the analgesic effect of iliocostalis plane block and thoracic paravertebral block after thoracoscopic surgery.Methods:Sixty patients who needed elective thoracoscopic surgery in our hospital from September 2020 to March 2023 were selected.The subjects were randomly divided into group T and group I,with 30 cases in each group.In group T,thoracic paravertebral block was performed before anesthesia induction,and in group I,iliocostalis plane block was performed before anesthesia induction.All patients in both groups were anesthetized with total intravenous anesthesia by contralateral bronchial intubation,and patient-controlled intravenous analgesia was performed after surgery.The ultrasound localization time,puncture time,and one-time puncture success rate of two groups of patients were recorded.The VAS scores of resting and motor pain for two groups of patients at 2,8,12,24,and 48 hours after surgery were recorded.The time of the first postoperative analgesia pump press and the number of analgesia pump presses within 48 hours after surgery for two groups of patients were recorded.The occurrence of adverse reactions 48 hours after surgery in two groups of patients were recorded.Results:Compared with group T,group I had significantly shorter ultrasound localization time and puncture time(P<0.05),and a significantly higher one-time puncture success rate(P<0.05).There was no statistically significant difference in VAS scores of resting and motor pain between the two groups of patients at different time points after surgery(P>0.05).The time of first PCA press and the number of effective press times of the analgesic pump within 48 hours after surgery were not statistically significant(P>0.05).Both groups of patients did not experience adverse reactions such as puncture site infection,hematoma,nausea,vomiting,or dizziness at 48 hours after surgery.Conclusion:Iliocostalis plane block or thoracic paravertebral block combined with intravenous analgesia are used for postopera

关 键 词：髂肋肌平面阻滞 胸椎旁阻滞 胸腔镜 疼痛 多模式镇痛 

分 类 号：R655[医药卫生—外科学]