摘要
目的比较超声引导下胸椎旁神经阻滞(TPVB)及胸腔镜直视下肋间神经阻滞(INB)用于胸腔镜肺大泡切除手术术后镇痛的效果。方法选择2017年11月至2018年12月汕头市中心医院择期全麻下行胸腔镜肺大泡切除手术患者80例,采用随机数字表法分为两组,每组40例:超声引导下TPVB组(T组)与胸腔镜直视下INB组(Ⅰ组)。记录术后1、6、12、24 h静息和活动视觉模拟评分(VAS),两组神经阻滞操作时间,术后24 h内需要追加止痛药例数,以及穿刺部位血肿、局麻药中毒、恶心、呕吐等并发症发生情况。结果 T组术后6 h静息VAS评分明显低于Ⅰ组(P<0.05);T组术后1、6、12 h活动VAS评分明显低于I组(P<0.05);Ⅰ组神经阻滞操作时间明显少于T组(P<0.05);两组间术后24 h内追加止痛药例数及相关并发症差异无统计学意义(P>0.05)。结论超声引导下TPVB与胸腔镜直视下INB均可用于胸腔镜下肺大泡切除术术后镇痛,并发症少,但前者镇痛效果更完全,后者操作更简便。选择何种阻滞镇痛模式取决于操作者的熟练程度和患者的具体情况及个体差异等。
Objective To compare the analgesic effects of ultrasound-guided thoracic paravertebral block(TPVB)and intercostal nerve block(INB)under thoracoscopy after thoracoscopic pulmonary bullectomy.Methods From November 2017 to December 2018,80 patients of elective general anesthesia underwent thoracoscopic pulmonary bullectomy,aged 15-69 years,weighed 41-77 kg,and American Society of Anesthesiologists(ASA)gradeⅠ-Ⅱin Shantou Central Hospital were randomly divided into ultrasound-guided TPVB group(group T)and thoracoscopy INB group(groupⅠ),40 cases in each group.The resting and active visual analogue score(VAS)at 1 h,6 h,12 h and 24 h after operation,the operation time of nerve block in the two groups,the number of patient who need analgesic drugs within 24 hours after operation,and complications such as the hematoma at the puncture site,local anesthetic poisoning,nausea and vomiting were recorded.Results The resting VAS score at 6 h after operation in group T was significantly lower than that in groupⅠ(P<0.05),and the active VAS score at 1 h,6 h and 12 h after operation in group T was significantly lower than that in groupⅠ(P<0.05).The time of nerve block operation in groupⅠwas significantly shorter than that in group T(P<0.05).There was no statistically significant difference in the number of patient who need analgesic drugs within 24 hours after operation and related complications(P>0.05).Conclusions Ultrasound-guided TPVB and thoracoscopic INB can be used for analgesia after thoracoscopic pulmonary bullectomy,with few complications,but the former has a more complete analgesic effect and the latter is easier to operate.The choice of block analgesic mode depends on the proficiency of the operator and the patient's specific conditions and individual differences.
作者
林梓霞
马楚洲
郭春明
张舟
Lin Zixia;Ma Chuzhou;Guo Chunming;Zhang Zhou(Department of Anesthesiology,Shantou Central Hospital,Shantou 515031,China)
出处
《中国医师杂志》
CAS
2020年第12期1827-1830,1835,共5页
Journal of Chinese Physician
基金
广东省汕头市科技计划项目(汕府科[2017]119号-21)。
关键词
胸腔镜检查
胸椎旁神经阻滞
肋间神经阻滞
肺大泡切除术
镇痛
Thoracoscopy
Thoracic paravertebral block
Intercostal nerve block
Pulmonary bullectomy
Analgesia
