超声引导肋间与胸椎旁神经阻滞对腔镜下肺叶切除术麻醉药用量及镇痛效果影响  

The impact of ultrasound-guided intercostal nerve block and thoracic paravertebral nerve block on anesthetic dosage and analgesic effect in video-assisted thoracoscopic lobectomy

作　　者：余昌伟[1] 叶建华 吴刚 唐爱平[1] YU Changwei;YE Jianhua;WU Gang;TANG Aiping(Department of Anesthesiology,Tongling People’s Hospital,Tongling 244000,China)

机构地区：[1]安徽省铜陵市人民医院麻醉科,244000

出　　处：《临床外科杂志》2025年第3期275-279,共5页Journal of Clinical Surgery

摘　　要：目的探讨超声引导肋间与胸椎旁神经阻滞对腔镜下肺叶切除术麻醉药用量及镇痛效果影响。方法2019年10月~2023年10月行腔镜下肺叶切除术病人90例,按麻醉方式分为两组,超声引导肋间神经阻滞(INB)组42例,采用超声引导肋间神经阻滞;超声引导胸椎旁神经阻滞(TPVB)组48例,采用超声引导胸椎旁神经阻滞。比较两组麻醉诱导前(T0)、麻醉15分钟(T1)、30分钟(T2)、45分钟(T3)、拔管后(T4)生命体征、麻醉药用量、镇痛效果、疼痛应激指标及不良反应。结果TPVB组T1、T2、T3、T4的收缩压(SBP)分别为(115.88±9.29)mmHg、(113.58±9.72)mmHg、(117.33±9.17)mmHg和(121.15±10.51)mmHg,舒张压(DBP)分别为(86.74±7.35)mmHg、(90.83±8.82)mmHg、(90.83±8.82)mmHg和(91.05±8.73)mmHg,心率(HR)分别为(79.94±7.46)、(81.97±7.28)、(82.36±7.41)、(85.83±8.32)次/分钟,均高于INB组的(103.53±8.28)mmHg、(105.40±8.66)mmHg、(109.03±8.13)mmHg、(114.64±9.65)mmHg,(77.68±6.57)mmHg、(79.27±6.69)mmHg、(83.21±7.37)mmHg、(85.83±8.21)mmHg,(71.17±6.21)次/分钟、(75.18±6.47)次/分钟、(74.82±6.12)次/分钟、(79.35±7.12)次/分钟,两组比较差异有统计学意义(P<0.05)。术后,TPVB组的24小时舒芬太尼用量为(27.68±2.64)μg,24小时镇痛泵按压次数为(5.16±0.38)次,低于INB组的(36.22±3.36)μg和(6.87±0.42)次,两组比较差异有统计学意义(P<0.05)。TPVB组静息、咳嗽时2、24、48小时的视觉模拟评分法(VAS)分别为(2.44±0.27)分、(3.55±0.42)分、(2.81±0.34)分,(3.36±0.23)分、(4.13±0.33)分、(3.80±0.25)分,低于INB组的(2.83±0.44)分、(3.98±0.55)分、(3.33±0.46)分,(3.87±0.30)分、(4.59±0.47)分、(4.17±0.29)分,两组比较差异有统计学意义(P<0.05)。TPVB组的前列腺素E2(PGE2)为(1.53±0.28μg/L),去甲肾上腺素(NE)为(362.25±33.85)ng/L、皮质醇(Cor)为(278.72±25.13)ng/L,低于INB组的(2.71±0.32)μg/L、(425.67±38.3)7ng/L和(315.68±29.21)ng/L,两组比较差异有统计学意义(P<0.05)。TPObjective To explore the effects of ultrasound-guided intercostal nerve block(INB)and thoracic paravertebral nerve block(TPVB)on the dosage of anesthetics and the efficacy of analgesia in video-assisted thoracoscopic lobectomy.Methods From October 2019 to October 2023,90 patients undergoing video-assisted thoracoscopic lobectomy at the People’s Hospital of Tongling City,Anhui,were selected.They were divided into the INB group(42 cases)and the TPVB group(48 cases).The INB group received ultrasound-guided intercostal nerve block,while the TPVB group was administered ultrasound-guided thoracic paravertebral nerve block.The two groups were compared before anesthesia induction(T0),15 minutes of anesthesia(T1),30 minutes of anesthesia(T2),45 minutes of anesthesia(T3),and after extubation(T4),vital signs,anesthetic dosage,analgesic effect,pain stress index and adverse reactions.Results In the TPVB group,systolic blood pressure(SBP)of T1,T2,T3 and T4 were(115.88±9.29)mmHg,(113.58±9.72)mmHg,(117.33±9.17)mmHg and(121.15±10.51)mmHg,respectively;diastolic blood pressure(DBP)were(86.74±7.35)mmHg,(90.83±8.82)mmHg,(90.83±8.82)mmHg and(91.05±8.73)mmHg,respectively;Heart rate(HR)were(79.94±7.46)times/min,(81.97±7.28)times/min,(82.36±7.41)times/min and(85.83±8.32)times/min,respectively.Which were all higher than the INB group[(103.53±8.28)mmHg,(105.40±8.66)mmHg,(109.03±8.13)mmHg,(114.64±9.65)mmHg.(77.68±6.57)mmHg,(79.27±6.69)mmHg,(83.21±7.37)mmHg,(85.83±8.21)mmHg,(71.17±6.21)times/min,(75.18±6.47)times/min,(74.82±6.12)times/min and(79.35±7.12)times/min,respectively],there were statistical significance between the two groups(P<0.05).Postoperatively,the TPVB group had lower 24-hour sufentanil consumption[(27.68±2.64)μg]and fewer presses of the analgesia pump[(5.16±0.38)times]compared to the INB group[(36.22±3.36)μg and(6.87±0.42)times,(P<0.05)].Visual analogue scale(VAS)scores for pain at rest and during coughing at 2,24,and 48 hours in group TPVB were 2.44±0.27,3.55±0.42,2.81±0.34 and 3.36±0.23,4

关 键 词：胸椎旁神经阻滞 肋间神经阻滞 腔镜下肺叶切除术 麻醉药用量 镇痛效果 

分 类 号：R61[医药卫生—外科学]