摘要
目的分析超声引导椎旁神经阻滞联合静脉自控镇痛在胸腔镜肺叶切除术(VATS)中的作用。方法选择医院2018年1月-2020年1月使用胸腔镜肺叶切除术治疗185例肺癌患者,采用随机数字法分成对照组和观察组,例数分别是91例和94例。对照组进行超声引导椎旁神经阻滞,观察组接受超声引导椎旁神经阻滞联合静脉自控镇痛。比较两组患者疼痛、胃肠道功能恢复、术后住院和PACU停留时间、阿片类药物使用量、不良反应、术后第1s用力呼气量、镇痛泵按压次数和补救镇痛药剂量。结果观察组患者术后1h、12h、24h静息、咳嗽数字模拟法(VAS)评分低于对照组(P<0.05)。观察组患者排气时间、排便时间、首次进食时间和肠鸣音恢复时间、术后住院和PACU停留时间少于对照组(P<0.05)。观察组患者瑞芬太尼和丙泊酚用量少于对照组(P<0.05)。观察组患者不良反应率高于对照组(P>0.05),差异比较无统计学意义。术后观察组患者镇痛泵按压次数和补救镇痛药剂量少于对照组(P<0.05),第1s用力呼气量多于对照组(P<0.05)。结论超声引导椎旁神经阻滞联合静脉自控镇痛能减少VATS患者疼痛和麻醉药物用量,促使呼吸、胃肠功能快速恢复,值得推广。
Objective To investigate the effect of ultrasound-guided paravertebral nerve block combined with patient-controlled intravenous analgesia in video-assisted thoracoscopic lobectomy(VATS).Methods A total of 185 patients with lung cancer underwent VATS in our hospital from January 2018 to January 2020 were enrolled,and divided into two groups by random number table methods.Control group(n=91)received ultrasound-guided paravertebral nerve block,while observation group(n=94)received ultrasound-guided paravertebral nerve block combined with patient-controlled intravenous analgesia.Then the pain degree,gastrointestinal function recovery,postoperative hospitalization and PACU stay length,opioid dosage,adverse reactions,postoperative forced expiratory volume in first second,PCIA pressing times,and postoperative analgesic dosage were compared between groups.Results At 1,12 and 24 hours after operation,the visual analogue scale(VAS)score in resting and coughing state of observation group was lower than that of control group(P<0.05).The exhaust time,defecation time,first eating time,bowel sounds recovery time,postoperative hospitalization and PACU stay time of observation group were shorter than those of control group(P<0.05).The dosage of remifentanil and propofol in observation group was less than that in control group(P<0.05).The adverse reaction rate of observation group was higher than that of the control group,with no significant difference(P>0.05).The postoperative PCIA pressing times and analgesic dosage of observation group were less than those of control group(P<0.05),and the forced expiratory volume in first second was higher than that of control group(P<0.05).Conclusion Application of ultrasound guided paravertebral nerve block combined with patient-controlled intravenous analgesia can reduce pain and anesthetic dosage in patients with VATS,and promote recovery the of respiratory and gastrointestinal functions,so it is worthy of recommendation.
作者
董三星
Dong Sanxing(The People's Hospital of Ruzhou,Ruzhou 467599,Henan,China)
出处
《辽宁医学杂志》
2021年第4期77-80,共4页
Medical Journal of Liaoning
关键词
超声
椎旁神经阻滞
静脉自控镇痛
胸腔镜肺叶切除术
疼痛
Ultrasound
Paravertebral nerve block
Patient-controlled intravenous analgesia
Thoracoscopic lobectomy
Pain
