摘要
目的研究开胸手术中直视下前路胸椎旁神经阻滞对麻醉效果的影响。方法选择择期行开胸肺癌根治术患者90例,随机分为超声组、对照组和阻滞组,每组30例。分别行不同方式胸椎旁神经阻滞,观察3组患者术中镇痛药用量,记录胸椎旁阻滞穿刺时间,观察术后苏醒期患者的躁动情况,记录患者术后4、8、12、24 h不同时点疼痛视觉模拟评分(VAS)以及不良反应情况。结果术中超声组及阻滞组瑞芬太尼的应用量较对照组减少(P<0.05);超声组和阻滞组苏醒期患者躁动及术后不良反应发生率均低于对照组(P<0.05);超声组和阻滞组术后各时间点视觉模拟评分均低于对照组(P<0.05)。结论直视下前路胸椎旁阻滞用于开胸患者手术可以减少术中瑞芬太尼用量,减轻患者术后疼痛,操作更直接,穿刺接近于零风险,更安全,而且在直视下穿刺更直观,阻滞效果更确切。
Objective To investigate the effects of anterior thoracic paravertebral nerve block under direct vision on anesthesia effect for thoracotomy.Methods A total of 90 patients with lung cancer who underwent elective thoracotomy were enrolled in the study,who were randomly divided into ultrasound group,control group and the block group,with 30 cases in each group.The different methods of thoracic paravertebral nerve block were performed respectively.The general data,duration of operation,intraoperative analgesic dosage in the three groups were observed,and the puncture time of thoracic paravertebral block was recorded.The restlessness of the patients in the postoperative recovery period was observed,and visual analog scale(VAS)pain score and adverse reactions at 4h,8h,12h,24 h after operation were observed and compared among the three groups.Results The application dosage of remifentanil intraoperatively in ultrasound group and block group was significantly lower than that in control group(P<0.05).The incidence rates of restlessness and postoperative adverse reactions in ultrasound group and block group were significantly lower than those in control group(P<0.05).The VAS scores at different time point after operation in ultrasound group and block group were significantly lower than those in control group(P<0.05).Conclusion Anterior thoracic paravertebral block under direct vision for thoracotomy can reduce the dosage of intraoperative remifentanil,and relieve postoperative pain.The operation is more direct and there is practically no risk of puncture.Therefore,it is safer,and ensures excellent exposure under direct vision,producing a good blocking effect.
作者
赵海蕊
张同军
柴鸣
靳伟
周红荣
王忠义
陈金辉
张帅
ZHAO Hairui;ZHANG Tongjun;CHAI Ming(Department of Anesthesiology,Hengshui People’s Hospital,Hebei,Hengshui 053000,China)
出处
《河北医药》
CAS
2022年第21期3285-3288,共4页
Hebei Medical Journal
基金
衡水市科学技术研究与发展计划项目(编号:2018014023Z)。
关键词
直视
前路
胸椎旁神经阻滞
开胸手术
direct vision
anterior approach
parathoracic nerve block
thoracotomy
