椎旁神经阻滞联合膈神经阻滞在开胸肺叶切除术中的应用  

Application of paravertebral nerve block combined with phrenic nerve block in thoracotomy lobectomy

作　　者：姬魁权 何锴 龙明波 张永国 陈绿绿 JI Kuiquan;HE Kai;LONG Mingbo;ZHANG Yongguo;CHEN Lyulyu(Department of Anesthesia,the People's Hospital of Qiannan Buyi and Miao Autonomous Prefecture,Guizhou Province,Duyun 558000,China)

机构地区：[1]贵州省黔南布依族苖族自治州人民医院麻醉科,贵州都匀558000

出　　处：《中国当代医药》2024年第3期18-23,共6页China Modern Medicine

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2023-411)。

摘　　要：目的探讨椎旁神经阻滞联合膈神经阻滞在开胸肺叶切除术中的应用。方法选择2021年1月至2023年4月于黔南布依族苖族自治州人民医院择期行开胸肺叶切除术患者105例作为研究对象,采用随机数字表法将其分为对照组(C组,n=35)、椎旁神经阻滞组(N组,n=35)和观察组(O组,n=35)。C组行全身麻醉诱导;N组行椎旁神经阻滞后全身麻醉诱导;O组行椎旁及膈神经阻滞后全身麻醉诱导。比较三组术中丙泊酚、瑞芬太尼用量、术后切口痛视觉模拟评分法(VAS)评分、同侧肩膀痛VAS评分、术后24 h内患者自控镇痛(PCA)使用次数。结果O组术中丙泊酚、瑞芬太尼用量低于C组、N组,差异有统计学意义(P<0.05);O组术后切口痛VAS评分低于C组,差异有统计学意义(P<0.05);O组术后同侧肩膀痛VAS评分低于C组、N组,差异有统计学意义(P<0.05);O组术后24 h内PCA使用次数低于C组、N组,差异有统计学意义(P<0.05)。结论椎旁神经阻滞联合膈神经阻滞在开胸肺叶切除术中的应用,能减少术中全身麻醉药的用量,能降低患者的术后切口疼痛及同侧肩膀痛,能减少术后PCA使用次数,值得在临床麻醉中普遍推广,让广大患受益。Objective To investigate the application of paravertebral nerve block combined with phrenic nerve block in thoracotomy lobectomy.Methods A total of 105 patients who had elective thoracotomy performed in the People's Hospital of Qiannan Buyi and Miao Autonomous Prefecture from January 2021 to April 2023 were selected as subjects and divided into control group(group C,n=35),paravertebral nerve block group(group N,n=35)and observation group(group O,n=35)by random number table method.Group C was directly induced by general anesthesia.Group N received general anesthesia induction after thoracic paravertebral nerve block.Group O was induced by general anesthesia after thoracic paravertebral nerve block.The intraoperative dosage of Propofol and Remifentanil,postoperative incision pain visual analogue scale(VAS)score,ipsilateral shoulder pain VAS score,the use of patient-controlled analgesia(PCA)within 24 h after surgery were compared among the three groups.Results The dosage of Propofol and Remifentanil in group O were lower than those in group C and N,and the differences were statistically significant(P<0.05).The VAS score of postoperative incision pain in group O was lower than that in group C,and the difference was statistically significant(P<0.05).The VAS score of ipsilateral shoulder pain in group O was lower than that in group C and group N,and the difference was statistically significant(P<0.05).The frequency of PCA use in group O within 24 hours after operation was lower than that in group C and group N,and the difference was statistically significant(P<0.05).Conclusion The application of paravertebral nerve block combined with phrenic nerve block in thoracotomy lobectomy can reduce the amount of general anesthetics during the operation,reduce the postoperative incision pain and ipsilateral shoulder pain of patients,reduce the number of postoperative PCA use.It is worthy to be popularized in clinical anesthesia to benefit the majority of patients.

关 键 词：椎旁神经阻滞 膈神经阻滞 开胸 肺叶切除术 

分 类 号：R614[医药卫生—麻醉学]