开胸术后持续肋间神经阻滞镇痛效果观察  

Observation of the analgesic effect of continuous intercostal nerve blockade via paravertebral thoracicepidural catheterization following thoracotomy

作　　者：孙毅 李长清 朱海媛 赵亚奇 SUN Yi;LI Changqing;ZHU Haiyuan;ZHAO Yaqi(Department of Thoracic Surgery,Linyi Central Hospital,Linyi,Shandong 276000,China;Department of Gastroenterology,Linyi Central Hospital,Linyi,Shandong 276000,China)

机构地区：[1]临沂市中心医院胸外科,山东临沂276000 [2]临沂市中心医院消化内科,山东临沂276000

出　　处：《宁夏医学杂志》2025年第2期139-142,共4页Ningxia Medical Journal

摘　　要：目的评价开胸手术中壁层胸膜外置入硬膜外管行肋间神经阻滞持续镇痛效果。方法纳入行下端食管及贲门癌开胸手术治疗患者60例,按照入院先后顺序随机分成持续胸膜外肋间神经阻滞组(A组,n=30)和单纯肋间神经阻滞组(B组,n=30)。比较2组患者术后疼痛程度以及使用补救镇痛药物的差异。结果A组患者术后2 d、3 d、4 d和5 d各时间点的VAS评分均低于B组,术后1 d、3 d和5 d的QoR-15评分均高于B组。与B组相比,A组患者术后首次使用补救镇痛的时间明显延迟,补救镇痛药物使用频率和剂量明显减少。结论开胸手术中壁层胸膜外置入硬膜外管持续肋间神经阻滞可有效减轻患者术后疼痛,减少补救镇痛措施,有利于提高患者术后早期恢复质量。Objective To assess the analgesic efficacy of continuous intercostal nerve blockade via paravertebral thoracic epidural catheterization in patients undergoing thoracotomy.Methods 60 patients undergoing thoracotomy for lower esophageal and cardia cancer were enrolled.Patients were randomly allocated into two groups based on the order of admission.All patients received a standard analgesic regimen and were further divided into the continuous paravertebral thoracic epidural intercostal nerve blockade group(Group A,n=30)and the simple intercostal nerve blockade group(Group B,n=30)based on different analgesic protocols.Postoperative pain levels and rescue analgesic usage were compared between the two groups.Results Patients in Group A had lower VAS scores on postoperative days 2,3,4,and 5 compared to Group B.Additionally,QoR-15 scores on postoperative days 1,3,and 5 were higher in Group A than in Group B.The time to first use of rescue analgesia postoperatively was significantly delayed in Group A compared to Group B,with a notable decrease in the frequency and dosage of rescue analgesics.Conclusion Continuous intercostal nerve blockade via paravertebral thoracic epidural catheterization during thoracotomy effectively mitigates postoperative pain and reduces the need for rescue analgesia,thereby enhancing early postoperative recovery quality in patients.

关 键 词：肋间神经阻滞 开胸手术 镇痛 

分 类 号：R614[医药卫生—麻醉学]