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| 超声引导下椎旁神经阻滞与肋间神经阻滞用于胸腔镜肺部术后镇痛效果的比较 |
| Comparison of analgesic effect of ultrasound-guided paravertebral block and intercostal nerve block after thoracoscopic pulmonary surgery |
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| DOI：10.12089/jca.2020.09.011 |
| 中文关键词: 椎旁神经阻滞 肋间神经阻滞 肺部手术 胸腔镜 |
| 英文关键词: Paravertebral nerve block Intercostal nerve block Thoracic surgery Thoracoscopic |
| 基金项目: |
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| 中文摘要: |
目的 探讨超声引导下椎旁神经阻滞与肋间神经阻滞对胸腔镜术后镇痛效果的影响。
方法 选取2016年1月至2018年12月择期行胸外科手术患者1 190例，男516例，女674例，年龄18~75岁，BMI 15~35 kg/m2，ASA Ⅰ—Ⅲ级。根据接受神经阻滞的类型分为两组：椎旁神经阻滞组（P组，n=327例）和肋间神经阻滞组（I组，n=863例）。P组术前行T3-4和T6-7椎旁神经阻滞；I组于手术结束时在胸腔镜监测下在切口及其相邻上下两个肋间实施肋间神经阻滞。记录患者性别、年龄、身高、体重，既往合并症，术后第1、2和3天舒芬太尼用量和镇痛泵有效按压次数，术后第1、2和3天静息和活动时疼痛数字（NRS）评分、恶心呕吐，记录术后头晕发生率和术后住院时间。
结果 与I组比较，P组术后第1和2天舒芬太尼用量明显减少（P<0.05），术后第1天镇痛泵有效按压次数明显减少（P<0.05），术后第1天活动时NRS评分、恶心呕吐发生率明显降低（P<0.05），术后头晕发生率明显降低(P<0.05)，术后住院时间明显缩短（P<0.05 ）。术后第2和3天两组静息和运动时NRS评分、恶心呕吐发生率差异无统计学意义。
结论 与肋间神经阻滞比较，椎旁神经阻滞可以减少胸腔镜肺部术后阿片类药物的用量，减少术后不良反应，缩短术后住院时间。 |
| 英文摘要: |
Objective To compare the effect of ultrasound-guided paravertebral block and intercostal nerve block on postoperative analgesia after thoracoscopic surgery.
Methods A total of 1 190 patients who undergoing thoracic surgery from January 2016 to December 2018 were selected, including 516 males and 674 females, aged 18-75 years, BMI 15-35 kg/m2, ASA physical status Ⅰ-Ⅲ. According to the type of nerve block, they were divided into the paravertebral nerve block group (group P, n = 327) and the intercostal nerve block group (group Ⅰ, n = 863). Preoperative T3-4 and T6-7 paravertebral blocks were performed in group P. At the end of the operation, intercostal nerve block was performed under thoracoscopic monitoring in group I. A research assistant who did not participate in the data analysis looked up the previous medical records and collected the relevant information of patients. The cumulative sufentanil consumption，pain score, incidence of postoperative nausea and vomiting, incidence of dizziness, and postoperative hospital stay were compared between the two groups.
Results Compared with group I, the dosage of sufentanil at the 1st d and 2nd d after operation in group P was significantly reduced (P < 0.05), the effective pressing times of analgesia pump at the 1st d after operation were significantly reduced (P < 0.05), the NRS score and the incidence of postoperative nausea and vomiting were significantly reduced at the 1st d after operation (P < 0.05), the incidence of dizziness was significantly reduced (P < 0.05), and the postoperative hospital stay was significantly shortened (P < 0.05). There was no significant difference in NRS score and incidence of postoperative nausea and vomiting between the two groups at the 2nd and 3rd d after operation.
Conclusion Compared with intercostal nerve block, paravertebral block in thoracoscopic pulmonary surgery can reduce the dosage of opioids, and has obvious advantages in postoperative analgesic effect and postoperative analgesia related adverse reactions, so that can shorten the postoperative hospital stay. |
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