摘要
目的探讨超声引导胸椎旁神经阻滞对自控静脉镇痛质量的影响。方法选取2015年12月~2016年12月惠州市中心人民医院麻醉科收治的90例择期行单侧开胸手术患者作为手术对象,按照随机数字表法将其分为三组,每组各30例。分别为自控静脉镇痛组(V组)、术前胸椎旁神经阻滞联合术后自控静脉镇痛组(P组)、自控硬膜外镇痛组(E组)。观察不同时点三组患者的平静及咳嗽时视觉模拟量表(VAS)疼痛评分、术后镇痛期间舒芬太尼用量、不良反应以及术前术后机体免疫功能指标T淋巴细胞亚群[分化簇3(CD3^+)、辅助/诱导T淋巴细胞(CD3^+CD4^+)、抑制/细胞毒T淋巴细胞(CD3^+CD8^+)、辅助/杀伤型T细胞(CD3^+CD4^+/CD4^+CD8^+)]。结果P组与E组术后2、4、8、12、24、48h的平静和咳嗽时VAS疼痛评分比较,差异无统计学意义(P>0.05);P组患者术后2、4、8、12、24h的平静及咳嗽时的VAS疼痛评分低于V组,差异有统计学意义(P<0.05);E组患者术后2、4、8、12、24、48h的平静及咳嗽时的VAS疼痛评分均低于V组,差异有统计学意义(P<0.05)。P组患者术后2、4、8、12h的Ramsay镇静评分低于V组,差异有统计学意义(P<0.05);E组患者术后2、4、8、12h的Ramsay镇静评分低于V组,差异有统计学意义(P<0.05);P组、E组患者术后2、4、8、12、24h的自控单次按压给药(PCA)按压次数均少于V组,差异有统计学意义(P<0.05)。E组和P组患者术后24、48h的舒芬太尼用量均少于V组,差异有统计学意义(P<0.05)。三组患者术后第1天的CD3^+、CD3^+CD4^+、CD3^+CD4^+/CD3^+CD8^+水平均低于术前1d,差异有统计学意义(P<0.05);V组患者术后第2天的CD3^+、CD3^+CD4^+、CD3^+CD4^+/CD3^+CD8^+水平低于术前1d,差异有统计学意义(P<0.05);P组、E组术后第2天的上述指标与术前1d比较,差异均无统计学意义(P>0.05)。P组和E组患者术后镇痛期间的恶心呕吐、嗜睡发生率低于V组,差异有统计学意义(P<0.05),E组术后
Objective To explore the effect of ultrasound-guided thoracic paravertebral nerve block on the quality of self-controlled intravenous analgesia.Methods A total of 90 patients who underwent unilateral thoracotomy in the department of anesthesiology,Huizhou Central People′s Hospital from December 2015 to December 2016 were selected as surgical objects.They were divided into three groups according to the random number table method,with 30 cases in each group.They were self-controlled intravenous analgesia group (group V),preoperative thoracic paravertebral nerve block combined with postoperative self-controlled intravenous analgesia group (group P),and self-controlled epidural analgesia group (group E),respectively.The visual analogue scale (VAS) pain scores at different time points of calm and cough,the dose of Sufentanil during postoperative analgesia,adverse reactions,and preoperative and postoperative immune function T lymphocyte subsets (differentiation cluster 3 [CD3^+],auxiliary/inducible T lymphocytes [CD3^+CD4^+],inhibitory/cytotoxic T lymphocytes [CD3^+CD8^+],and helper/killer T cells [CD3^+CD4^+/CD4^+CD8^+]).Results The VAS pain scores at 2,4,8,12,24 and 48 h after surgery of calm and cough in group P and group E showed no statistically significant difference (P>0.05).The VAS pain scores at 2,4,8,12 and 24 h after surgery of calm and cough in the group P were lower than those in the group V,the differences were statistically significant (P<0.05).The VAS pain scores at 2,4,8,12,24 and 48 h after surgery of calm and cough in group E were lower than those in group V,the differences were statistically significant (P<0.05).The Ramsay sedation scores at 2,4,8 and 12 h after surgery in the group P were lower than those in the group V,the differences were statistically significant (P<0.05).The Ramsay sedation scores at 2,4,8 and 12 h after surgery of patients in group E were lower than those in group V,the differences were statistically significant (P<0.05).Patients in the group P and group E at 2,4,8,12 and 24
作者
邱柳基
陈裕强
徐瑶
罗德兴
孙来保
QIU Liu-ji;CHEN Yu-qiang;XU Yao;LUO De-xing;SUN Lai-bao(Department of Anesthesiology,Huizhou Central People′s Hospital,Guangdong Province,Huizhou 516001,China;Department of Anesthesiology,the First Affiliated Hospital of Zhongshan University,Guangdong Province,Guangzhou 510000,China)
出处
《中国当代医药》
2019年第22期8-14,共7页
China Modern Medicine
基金
广东省惠州市医疗卫生类科技计划项目(2017Y005)
关键词
超声引导
胸椎旁神经阻滞
自控静脉镇痛
免疫功能
Ultrasound guided
Thoracic paravertebral nerve block
Self-controlled intravenous analgesia
Immune function
