胸腔镜手术硬膜外镇痛与椎旁阻滞的比较  

Epidural Analgesia versus Paravertebral Block in Video-Assisted Thoracoscopic Surgery

作　　者：赵集 杨敏[1] 刘闵 李炬颖 吴丹 

机构地区：[1]延安大学附属医院,陕西 延安

出　　处：《医学诊断》2020年第3期164-167,共4页Medical Diagnosis

摘　　要：在胸腔镜手术患者中,在疼痛控制和术后并发症发生率方面,多数研究结果表明,椎旁阻滞(paravertebral block, PVB)优于硬膜外镇痛(epidural analgesia, EP)。目前,直接比较PVB和EP在疼痛控制和术后结局方面的研究数量有限,尚无大规模的随机试验报道。但其中有4篇论文为此提供了最好的证据说明,四篇中有3篇是小型前瞻性随机试验,最后一篇文献是一项小的队列研究。从疼痛控制的角度来看,没有确凿的证据表明这两种方法谁更有效;一项研究表明EP显著降低了疼痛水平(P = 0.01),第二项研究表明PVB明显改善了疼痛控制(P 【0.01),第三项研究未能证明任何显著差异(P = 0.899)。PVB组和EP组需要追加镇痛的频率相似(56% vs 48%, P = 0.26)。与EP相比,PVB的术后并发症发生率更低,特别是尿潴留(64% vs 34.6%, P = 0.0036)和低血压(32% vs 7%, P = 0.0031;21% vs 3%, P = 0.02) 。而在PVB组中,联合使用舒芬太尼的研究较少,其安全性和有效性值得我们深入研究。According to most research results, in patients undergoing video-assisted thoracoscopic surgery, paravertebral block (PVB) is superior to epidural analgesia (EP) in terms of pain control and its postoperative complication rates. At present, there are a limited number of studies directly com-paring pain control and postoperative outcomes between PVB and EP, and no large-scale random-ized trials have been reported. But, there were four papers that represented the best evidence to answer the clinical question. Three of the 4 papers are small prospective randomized trials, with a small cohort study featuring as the final piece of literature. There is no conclusive body of evidence to recommend either route as more efficacious from a pain control perspective;one study demonstrated significantly lower levels of pain with EP (P = 0.01), with a second study demon-strating significantly better pain control with PVB (P <0.01) and a third failing to demonstrate any significant difference (P = 0.899). The frequency of requiring supplemental analgesia was similar between the PVB and EP cohorts (56% vs 48%, P = 0.26). PVB is associated with lower rates of postoperative complications compared to EP, specifically urinary retention (64% vs 34.6%, P = 0.0036) and hypotension (32% vs 7%, P = 0.0031;21% vs 3%, P = 0.02). In the PVB group, there are few studies on the combined use of sufentanil, and its safety and effectiveness deserve our in-depth study.

关 键 词：胸腔镜手术 椎旁阻滞 硬膜外镇痛 舒芬太尼 

分 类 号：R61[医药卫生—外科学]