摘要
目的探讨术前超声引导下肋间神经阻滞联合术后小剂量舒芬太尼静脉自控镇痛(patientcontrolled intravenous analgesia,PCIA)对老年开胸手术镇痛效果及对老年患者术后恢复的影响。方法选取本院2017年6月—2018年6月拟在全麻下行择期行经肋开胸食管癌根治术的老年患者90例,男49例,女41例,年龄65～79岁,ASAⅡ～Ⅲ级。随机分为S组:单纯3.0μg/kg舒芬太尼静脉镇痛(n=30);RS1组:0.75%罗哌卡因肋间神经阻滞+3.0μg/kg舒芬太尼静脉镇痛(n=30); RS2组:0.75%罗哌卡因肋间神经阻滞+1.5μg/kg舒芬太尼静脉镇痛(n=30)。观察3组患者拔管后生命体征、苏醒后4、8、12、24小时患者的VAS评分、Prince-Henry评分法及镇痛泵自控次数、术后呼吸功能的恢复及术后不良反应情况。结果 RS1组与RS2组术中及术后生命体征较S组平稳(P<0.05);与S组相比,RS2组各时点VAS未见显著差异(P>0.05); RS1组明显降低(P<0.05);与S组相比,RS1组及RS2组P-H评分显著降低,且RS1组较RS2组明显降低; RS1组与RS2组术后PaO2、PaCO2均优于S组(P<0.05)。结论术前肋间神经阻滞联合术后小剂量舒芬太尼PCIA能有效减轻运动痛,降低术后肺部并发症的发生,并减少舒芬太尼用量,保障老年患者术后管理。
Objective To investigate the analgesic effect of preoperative ultrasound-guided intercostal nerve block combined with postoperative patient-controlled intravenous analgesia( PCIA) in analgesia for elderly patients underwent thoracotomy and its effect on postoperative recovery. Methods From June 2017 to June 2018,90 cases of elderly patients were enrolled in this study,those who will undergo transcostal thoracotomy for radical resection of esophageal carcinoma under general anesthesia. Among them,there were 49 cases of male and 41 cases of female,and aged from 65 to 79 years old,ASA was between levels II to III. The patients were divided into three groups. Patients in S group adopted sufentanil( 3.0μg/kg) intravenous analgesia only( n = 30).In RS1 group,0. 75% ropivacaine was used for intercostal nerve block combined with 3. 0 μg/kg sufentanil intravenous analgesia( n = 30). In RS2 group,0.75% ropivacaine was used for intercostal nerve block combined with 1.5μg/kg sufentanil intravenous analgesia( n = 30). Vital signs after the drawing of catheter,VAS score of the patients after 4,8,12,and 24 hours awake,Prince-Henry scores,times of analgesia pump control,the recovery of postoperative respiratory function and postoperative adverse reactions of the two groups were observed.Results The intra-operative and postoperative vital signs of RS1 group and RS2 group were more stable than those of S group( P<0.05). Compared with group S,there was no significant difference in VAS at each time point in the RS2 group( P>0.05).These of RS1 group decreased significantly( P<0.05). Compared with group S,the P-H score of RS1 group and RS2 group was significantly decreased,and that of RS1 group was significantly lower than that of RS2 group. Both PaO2 and PaCO2 in RS1 group and RS2 group were better than those in S group( P< 0. 05). Conclusions Preoperative intercostals nerve block in combination with small dose of sufentanil postoperative PCIA could effectively relieve motivate pain,reduce the postoperative pulmonary complications
作者
张雪琴
方诗伟
梁启胜
席彪
Zhang Xue-qin(Department of postgraduate,Bengbu Medical College,Bengbu,Anhui,233004,China)
出处
《齐齐哈尔医学院学报》
2018年第20期2376-2380,共5页
Journal of Qiqihar Medical University
关键词
胸科手术
超前镇痛
术后镇痛
肋间神经阻滞
Thoracic surgery
Advanced analgesia
Postoperative analgesia
Intercostal nerve block
