超声引导下RLB、PVB在胸腔镜肺叶切除术中的应用价值  

Application Value of Ultrasound-guided RLB and PVB in Thoracoscopic Pulmonary Lobectomy

作　　者：自华芬 史婧弘 陈莉 ZI Huafen;SHI Jinghong;CHEN Li(First Affiliated Hospital of Chengdu Medical College,Chengdu 610012,China)

机构地区：[1]成都医学院第一附属医院,四川成都610012

出　　处：《北华大学学报（自然科学版）》2024年第2期209-213,共5页Journal of Beihua University（Natural Science）

基　　金：成都医学院第一附属医院专项基金(CYFY2019YB04)。

摘　　要：目的探讨超声引导下后路椎板阻滞(RLB)与椎旁阻滞(PVB)在胸腔镜肺叶切除术中的应用价值。方法选取122例行胸腔镜肺叶切除术患者,应用数字表法将其随机分为RLB组和PVB组,每组61例,术毕均进行静脉自控镇痛(PCIA),比较两组患者不同时间点(入室后(T_(0))、切皮前(T_(1))、切皮1 min(T_(2))、切皮5 min(T_(3)))心率(HR)与平均动脉压(MAP)、手术时间、术中出血量、补液量、瑞芬太尼使用量、术中低血压发生率、自主呼吸恢复时间及苏醒时间;比较两组患者术后静息态疼痛数字分级法(NRS)评分、PCIA首次按压时间与有效按压次数、补救镇痛率及术后不良反应。结果两组T_(0)、T_(1)、T_(2)、T_(3) HR及MAP比较差异无统计学意义(P>0.05);两组患者手术时间、术中出血量、补液量及瑞芬太尼使用量比较差异无统计学意义(P>0.05);RLB组低血压发生率明显低于PVB组(P<0.05);两组自主呼吸恢复时间、苏醒时间及术后各时间点NRS评分比较差异无统计学意义(P>0.05);两组PCIA首次按压时间、PCIA有效按压次数、补救镇痛率及术后不良反应总发生率比较差异无统计学意义(P>0.05)。结论超声引导下RLB与PVB应用于胸腔镜肺叶切除术均能获得良好镇痛效果,但RLB具有术中低血压发生率低的优点。Objective To compare the application value of ultrasound-guided retrolaminal block(RLB)and paravertebral block(PVB)in thoracoscopic pulmonary lobectomy.Method A total of 122 patients underwent thoracoscopic pulmonary lobectomy were selected,and divided into RLB group and PVB group by random number table method,61 cases in each group.All underwent patient-controlled intravenous analgesia(PCIA)after operation.The terms of heart rate(HR)and mean arterial pressure(MAP)after entering the room(T_(0)),before skin incision(T_(1)),at 1 min after skin incision(T_(2))and 5 min after skin incision(T_(3)),operation time,intraoperative blood loss,fluid infusion volume,the dosage of Remifentanil,the incidence of intraoperative hypotension,recovery time of spontaneous breathing,awakening time were compared between two groups.The numerical rating scale(NRS)score in resting state,the first pressing time and effective pressing times of PCIA,rescue analgesia rate,and postoperative adverse reactions were compared between two groups.Results There had similar HR and MAP at T_(0),T_(1),T_(2) and T_(3) between two groups(P>0.05).The operation time,intraoperative blood loss,fluid infusion volume and the dosage of Remifentanil showed no significant difference between the two groups(P>0.05).The incidence of hypotension in RLB group was significantly lower than that in PVB group(P<0.05).The recovery time of spontaneous breathing,awakening time,NRS score,the first pressing time and effective pressing times of PCIA,rescue analgesia rate,and the total incidence of postoperative adverse reactions showed no significant difference between the two groups(P>0.05).Conclusion Ultrasound-guided RLB and PVB can achieve good analgesic effects in patients undergoing thoracoscopic pulmonary lobectomy.However,RLB has the advantage of reducing the incidence of intraoperative hypotension.

关 键 词：超声引导 胸腔镜肺叶切除术 后路椎板阻滞 椎旁阻滞 镇痛 

分 类 号：R614[医药卫生—麻醉学]