摘要
目的探讨在胸腔镜肺叶切除术后应用超声引导下行肋间神经阻滞(INB)镇痛的临床效果。方法80例胸心外科行择期胸腔镜肺叶切除术患者,随机分为INB组和静脉自控镇痛(PCIA)组,每组40例。INB组患者于关胸后超声引导下采用盐酸罗哌卡因进行第5肋INB,PCIA组待患者麻醉复苏后予以行PCIA。比较两组术后首次胃肠道排气情况、术后不良反应发生情况、术后追加地佐辛用量及带管时间、患者术后不同时间的视觉模拟评分法(VAS)评分与Prince-Henry评分法(PHPS)评分。结果术后INB组患者首次胃肠道排气情况与PCIA组比较,差异无统计学意义(P>0.05)。INB组恶心、呕吐发生率分别为10.0%、5.0%,均低于PCIA组的37.5%、20.0%,差异均具有统计学意义(P<0.05)。两组眩晕、过度镇静、皮肤瘙痒发生率比较,差异均无统计学意义(P>0.05)。INB组患者术后追加地佐辛用量(17.12±7.50)mg少于PCIA组的(22.12±6.87)mg,差异具有统计学意义(P<0.05)。两组患者术后带管时间比较,差异无统计学意义(P>0.05)。虽然INB组患者术后6、12、24 h的VAS评分均高于PCIA组,但术后48、72 h的VAS评分均低于PCIA组,且术后6、12、24、48、72 h的PHPS评分均低于PCIA组,差异均具有统计学意义(P<0.05)。结论胸腔镜肺叶切除术后超声引导下行INB镇痛更佳,患者镇痛效果满意,降低患者术后不良反应发生率,有利于加速患者胸腔镜肺部手术后的快速康复,更利于在临床实践中应用。
Objective To discuss the clinical effect of analgesic effect of ultrasound-guided intercostal nerve block(INB)on analgesia after thoracoscopic lobectomy.Methods A total of 80 patients undergoing elective thoracoscopic lobectomy in thoracic surgery were randomly divided into INB and patient-controlled intravenous analgesia(PCIA)groups,with 40 patients in each group.Patients in INB group were treated with ropivacaine hydrochloride for the 5th rib INB under the guidance of ultrasound after chest closure,and patients in PCIA group were treated with PCIA after anesthesia and resuscitation.Both groups were compared in terms of first postoperative gastrointestinal exhaust,postoperative adverse reactions,postoperative additional dezocine dosage,catheterization time,and visual analogue scale(VAS)scores and Prince-Henry pain score(PHPS)at different time points.Results There was no statistically significant difference in first postoperative gastrointestinal exhaust between the INB group and the PCIA group(P>0.05).The incidences of nausea and vomiting in the INB group were 10.0%and 5.0%,respectively,which were lower than 37.5%and 20.0%of the PCIA group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of dizziness,excessive sedation,and skin pruritus between the two groups(P>0.05).The postoperative additional dose of dezocine(17.12±7.50)mg in the INB group was less than(22.12±6.87)mg in the PCIA group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in postoperative catheterization time between the two groups(P>0.05).Although VAS scores in the INB group were higher than those in the PCIA group at 6,12,and 24 h postoperatively,VAS scores at 48 and 72 h postoperatively were lower than those in the PCIA group,and PHPS scores at 6,12,24,48,and 72 h postoperatively were lower than those in the PCIA group.All the differences were statistically significant(P<0.05).Conclusion After thoracoscopic lob
作者
鲁立军
高双庆
郭圣治
刘慧敏
李玮
LU Li-Jun;GAO Shuang-qing;GUO Sheng-zhi(Caoxian County People’s Hospital,Heze 274400,China)
出处
《中国实用医药》
2021年第28期5-8,共4页
China Practical Medicine
关键词
胸腔镜肺叶切除术
超声引导
肋间神经阻滞镇痛
临床效果
Thoracoscopic lobectomy
Ultrasound guidance
Intercostal nerve block analgesia
Clinical effect
