胸椎旁神经阻滞用于不停跳冠状动脉旁路移植术患者围手术期镇痛作用研究  

Effect of thoracic paravertebral block on perioperative analgesia in patients undergoing off-pump coronary artery bypass grafting surgery

作　　者：方印 龚婵娟 陈宇 FANG Yin;GONG Chanjuan;CHEN Yu(Department of Anesthesia and Perioperative Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,南京210029

出　　处：《临床药物治疗杂志》2024年第8期35-39,共5页Clinical Medication Journal

基　　金：国家自然青年基金(82101278)。

摘　　要：目的 探讨胸椎旁神经阻滞(TPVB)作为辅助镇痛手段用于不停跳冠状动脉旁路移植术(CABG)的有效性及安全性。方法 选取2022年3月至2023年9月南京医科大学第一附属医院择期进行不停跳CABG的患者,采用随机数字表法将其分为TPVB组(观察组)和传统麻醉组(对照组)。观察组患者术前接受超声引导下双侧TPVB,对照组患者术前无特殊处理。比较两组患者的镇痛效果、恢复情况及安全性。结果 共纳入60例患者,观察组和对照组各30人。观察组患者的静态/动态视觉模拟评分法(VAS)评分在术后24、48 h均低于对照组(P<0.05),但术后72 h两组静态/动态VAS评分比较,差异无统计学意义(P>0.05)。观察组患者的病人自控镇痛(PCA)起始按压时间为(5.1±1.2)h,晚于对照组的(2.0±0.9)h,且观察组患者术后24、48 h的PCA按压次数[2(1,4)次,5(3,7)次]少于对照组[4(3,5)次,7(5,9)次,P<0.01],但术后72 h两组PCA按压次数比较,差异无统计学意义(P>0.05)。观察组患者术中瑞芬太尼用量、术后镇痛药物补救次数均少于对照组[1.0(0.5,1.6)mg比2.2(1.8,2.5) mg,1(0,1)次比3(2,3)次],术后拔管时间和ICU停留时间均短于对照组[(5.4±2.5)h比(7.0±2.9)h,(10.8±3.2)h比(13.7±3.9)h],差异有统计学意义(P<0.05),但两组患者术后住院时间比较,差异无统计学意义(P>0.05)。观察组患者术后72 h内的恶心和呕吐发生率均低于对照组(20.0%比50.0%,10.0%比36.7%),差异有统计学意义(P<0.05)。结论 应用TPVB能提升不停跳CABG患者部分术后早期镇痛效果评价指标,减少镇痛药物剂量,且安全性良好。Objective To investigate the efficacy and safety of thoracic paravertebral block(TPVB)as an adjuvant analgesic method in patients undergoing off-pump coronary artery bypass grafting(CABG).Methods Patients scheduled for elective off-pump CAGB at the First Affiliated Hospital of Nanjing Medical University from March 2022 to September 2023 were enrolled and randomly assigned to the TPVB group(observation group)or the traditional anesthesia group(control group)using a random number table.Patients in the observation group received ultrasound-guided bilateral TPVB before surgery,while those in the control group received no special preoperative treatment.The analgesic effect,recovery,and safety were compared between the two groups.Results A total of 60 patients were included,30 cases in the observation group and 30 cases in the control group.The static and dynamic visual analogue scale(VAS)scores were lower in the observation group than that in the control group at 24 and 48 hours postoperatively(P<0.05),but there was no significant difference between the two groups at 72 hours postoperatively(P>0.05).The time to first patient-controlled analgesia(PCA)press was significantly delayed in the observation group[(5.1±1.2)h]compared to the control group[(2.0±0.9)h],and the number of PCA presses was lower in the observation group at 24 and 48 hours postoperatively[2(1,4)number of times vs 4(3,5)number of times,5(3,7)number of times vs 7(5,9)number of times,P<0.01].However,there was no significant difference in PCA presses between the two groups at 72 hours postoperatively(P>0.05).Patients in the observation group had lower intraoperative remifentanil consumption and fewer postoperative rescue analgesic administrations[1.0(0.5,1.6)mg vs 2.2(1.8,2.5)mg,1(0,1)number of times vs 3(2,3)number of times,respectively],as well as shorter postoperative extubation time and ICU stay[(5.4±2.5)h vs(7.0±2.9)h,(10.8±3.2)h vs(13.7±3.9)h],with statistically significant differences(P<0.05).However,there was no significant difference in pos

关 键 词：胸椎旁神经阻滞 冠状动脉旁路移植术 冠心病 围手术期镇痛 安全性 

分 类 号：R971.2[医药卫生—药品]