摘要
目的探讨超声引导下椎旁置管行连续胸椎旁神经阻滞(CTPB)和静脉自控镇痛(PCIA)对多发肋骨骨折患者术后镇痛效果及肺功能的影响。方法选取2020年1月—2022年1月于宜昌市中心人民医院收治的46例行择期切开复位内固定术的创伤性多发肋骨骨折患者,采用随机数字表法分为CTPB组和PCIA组,每组23例。PCIA组采用舒芬太尼联合氟比洛芬酯静脉镇痛,CTPB组术后于患侧选定适宜的3个椎旁间隙在超声引导下置管,应用罗哌卡因行连续胸椎旁肋间神经阻滞,阻滞镇痛至术后72 h。分别于术前(T0)、术后3 h(T1)、1 d(T2)、2 d(T3)、3 d(T4)记录胸壁疼痛视觉模拟评分(VAS)并采集动脉血,检测二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、氧和指数(PaO_(2)/FiO_(2)),并检测T0及T4时第一秒用力呼气量(FEV_(1))和FEV_(1)占用力肺活量百分比(FEV_(1)%)。结果与T0比较,两组术后T1、T2、T3、T4时的静息、咳嗽VAS降低(均P<0.05),动脉血PaO_(2)、PaO_(2)/FiO_(2)升高(均P<0.05)。CTPB组术后T4的FEV_(1)、FEV_(1)%较PCIA组升高(均P<0.05)。结论多发肋骨骨折术后行CTPB阻滞较PCIA镇痛效果更好并且可以改善术后氧和功能及肺通气。
Objective To investigate the effect of ultrasound guided paravertebral catheterization paravertebral block(CTPB)and patient-controlled intravenous analgesia(PCIA)on postoperative analgesia and pulmonary function in patients with multiple rib fractures.Methods Totally 46 cases of trauma patients with multiple rib fractures who underwent internal fixation admitted to Yichang Central People′s Hospital from Jan.2020 to Jan.2022 were included in this study.All patients were underwent internal fixation during hospitalization.Among them,46 patients were divided into CTPB group(n=23)and PCIA group(n=23)using random number table method.In PCIA group,sufentanil+flurbiprofen axetil were used for intravenous analgesia.In the CTPB group,a suitable ultrasound guided catheter was placed for continuous thoracic paravertebral intercostal nerve block with ropivacaine after operation.All patients were observed until the 3rd day after operation.Chest wall pain VAS score in the resting/cough state,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),Before the operation(T0),at 3h(T1),1 day(T2),2 days(T3),3 days(T4)after analgesia,arterial blood samples were collected to lest the levels of Pa02,PaC02 and Pa02/FiO_(2).The pulmonary function was also examined before(T0)and 3 days(T4)after the operation through FEV_(1) and FEV_(1)%.Results CTPB group compared with the PCIA group at T 1,T 2,T 3 and T 4 after analgesia,the level of resting and coughing VAS were significantly decreased(P<0.05),the level of PaO_(2) and PaO2/FiO2 were increased(P<0.05),and FEV_(1),FEV_(1)%were increased(P<0.05)at 3 d after analgesia.Conclusion Compared with the PCIA,CTPB improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple rib fractures after internal fixation operation.
作者
刘恒山
谢辉晋
张松林
寿康全
朱高波
LIU Hengshan;XIE Huijin;ZHANG Songlin;SHOU Kangquan;ZHU Gaobo(Department of Emergency and Trauma,Yichang Central People′s Hospital,Yichang 443003,Hubei,China;Department of Cardiothoracic Surgery,Yichang Central People′s Hospital,Yichang 443003,Hubei,China;Department of Orthopedics,Yichang Central People′s Hospital,Yichang 443003,Hubei,China)
出处
《西部医学》
2024年第4期529-533,共5页
Medical Journal of West China
基金
湖北省自然科学基金项目(2021CFB488)。
关键词
肋骨骨折
胸椎旁神经阻滞
镇痛
超声引导
Rib fracture
Thoracic paravertebral block
Analgesia
Ultrasound guided
