摘要
目的观察超声引导下胸椎旁神经阻滞用于腹腔镜胆囊切除术后镇痛的临床效果。方法随机选择我院2017年7~11月择期行腹腔镜胆囊切除手术患者150例。随机分为三组,每组50例:A组为椎旁神经阻滞镇痛组,B组为罗哌卡因分层局麻加腹腔内表面麻醉镇痛组,C组为静脉镇痛泵(PCIA)组。其中A组为实验组,B组和C组为对照组。观察三组患者在术后4 h、8 h、12 h、24 h时切口痛和非切口痛的VAS评分;同时记录患者手术后头晕、恶心、呕吐、皮肤瘙痒、肛门恢复排气时间以及低血压等发生情况。结果术后24 h内各时间点A组与B组、C组患者比较,血压变化、手术切口痛VAS评分无统计学差异(P>0.05)。各时间点非切口痛VAS评分A组低于B组(P<0.01)。24 h内头晕、恶心、呕吐和皮肤瘙痒发生率A组低于C组(P<0.01)。术后肛门恢复排气时间A组短于C组(P<0.05)。结论超声引导下胸椎旁神经阻滞用于腹腔镜胆囊切除术后镇痛的镇痛效果确切,同时对于术后非切口疼痛的内脏痛、肩背部和肋间牵涉痛具有镇痛效果,且不良反应低。
Objective To observe the analgesic clinical effect of ultrasound-guided thoracic paravertebral blockade in treatment of patients undergoing laparoscopic cholecystectomy.Methods 150 patients who would receive elective laparoscopic cholecystectomy in the First Hospital of Jiaxing from July to November 2017,were selected and randomly divided into three groups with 50 cases in each group.Group A received thoracic paravertebral blockade and Group B received ropivacaine stratified local anesthesia and intraperitoneal surface anesthesia to ease pain.Group C received PCIA.Group A was experimental group,while group B and C were control group.The VAS scores of incisional pain and non-incisional pain at 4 h,8 h,12 h and 24 h after operation of 3 groups were observed,and the incidence of symptoms including dizziness,nausea,vomiting,skin pruritus and hypotension and recovery time for anal exsufflation after operation were recorded.Results The change of blood pressure and the VAS score of surgical incision pain of group A,B and C at each time in 24 hours after operation had no significant differences（P〉0.05）.The VAS score of non-incisional pain at each time of group A was lower than that of group B（P〈0.01）.The incidence rates of dizziness,nausea,vomiting and skin pruritus in 24 hours after operation of group A were lower than those of group C（P〈0.01）.The recovery time for anal exsufflation after operation of group A was shorter than that of group C（P〈0.05）.Conclusion The ultrasound-guided thoracic paravertebral blockade in treatment of patients undergoing laparoscopic cholecystectomy has clear analgesic effect,besides,which also has analgesic effect on postoperative non-incision pain of visceral,shoulder and back and intercostal involvement and less side effects.
作者
吴振威
倪华栋
侯晓敏
姚明
WU Zhenwei;NI Huadong;HOU Xiaomin;YAO Ming(Department of Anesthesiology,the First Hospital of Jiaxing City in Zhejiang Province,Jiaxing 314000,China)
出处
《中国现代医生》
2018年第22期99-103,共5页
China Modern Doctor
基金
浙江省区域专病中心建设项目(浙卫发[2015]21号)
浙江省嘉兴市第一医院院级课题(壹计划)(2017-YA-34)
关键词
超声引导
胸椎旁神经阻滞
术后镇痛
腹腔镜胆囊切除术
Ultrasound-guided
Thoracic paravertebral blockade
Postoperative analgesia
Laparoseopie eholeeysteetomy
