文章摘要
超声引导下横突-胸膜中点阻滞与胸椎旁神经阻滞用于单孔胸腔镜手术后镇痛效果的比较
Comparison of postoperative analgesic effects between ultrasound-guided mid-point transverse process to pleura block and thoracic paravertebral block in patients undergoing uniportal video-assisted thoracoscopic surgery
  
DOI：10.12089/jca.2020.12.007
中文关键词: 横突-胸膜中点阻滞  椎旁神经阻滞  单孔胸腔镜  术后镇痛
英文关键词: Mid-point transverse process to pleura block  Thoracic paravertebral block  Uniportal video-assisted thoracoscopic surgery  Postoperative analgesia
基金项目:
作者单位E-mail
陈旭 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
章蔚 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
王迪 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
谢言虎 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
王胜 230001,合肥市,中国科学技术大学附属第一医院麻醉科 18935701573@163.com 
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中文摘要:
      
目的 比较超声引导下横突-胸膜中点阻滞(MTPB)与胸椎旁神经阻滞(TPVB)用于单孔胸腔镜手术术后镇痛的效果。
方法 选择择期行单孔胸腔镜手术患者80例，男36例，女44例，年龄18～65岁，BMI 19～28 kg/m2，ASA Ⅰ―Ⅲ级。采用随机数字表法分为MTPB组（M组）和TPVB组（P组），每组40例。手术结束后M组行超声引导下MTPB，P组行TPVB，两组均注射0.5%罗哌卡因15 ml。两组患者术后均采用PCIA。记录神经阻滞操作时间、穿刺深度，记录术后2、6、12、24、48 h安静和咳嗽时VAS疼痛评分，记录镇痛泵首次按压时间、总按压次数、舒芬太尼使用量和补救镇痛例数，记录穿刺相关并发症、镇痛不良反应发生情况。
结果 与P组比较，M组神经阻滞操作时间明显缩短（P<0.05），进针深度明显变浅（P<0.05）。术后2、6、12、24、48 h两组安静和咳嗽时VAS疼痛评分差异无统计学意义。两组患者术后镇痛泵首次按压时间、总按压次数、舒芬太尼用量和补救镇痛率差异无统计学意义。两组患者术后恶心、呕吐等不良反应差异无统计学意义。
结论 MTPB或TPVB联合术后PCIA应用于单孔胸腔镜手术患者，术后均可取得良好的镇痛效果，但MTPB操作简单、安全，可作为单孔胸腔镜手术患者术后镇痛方案的选择。
英文摘要:
      
Objective To compare postoperative analgesic effects between ultrasound-guided mid-point transverse process to pleura block (MTPB) and thoracic paravertebral block (TPVB) in patients undergoing uniportal video-assisted thoracoscopic surgery (uVATS).
Methods A total of 80 patients of both genders undergoing uniportal VATS was recruited, 36 males and 44 females, aged 18-65 years, BMI 19-28 kg /m2, ASA physical status Ⅰ-Ⅲ. The patients were randomly divided into MTPB group (group M) and thoracic paravertebral block group (group P), 40 patients in each group. All patients received patient-controlled intravenous analgesia (PCIA) after operation. Group M performed ultrasound-guided MTPB and group P performed TPVB, 0.5% ropivacaine 15 ml were used in the two groups. The duration and depth of block were recorded. The VAS scores during rest and cough at 2, 6, 12, 24, and 48 h after operation were recorded. The time of first press, the frequency of pressing PCIA, sulfentanyl consumption, and the cases of remedial analgesia were also recorded. The puncture-related complications and analgesic adverse reactions were recorded.
Results Compared with group P, the operation time of nerve block was significantly shorter (P < 0.05) and the depth of needle was shallower (P < 0.05) in group M. The VAS scores during rest and cough 2, 6, 12, 24, and 48 h after operation in both groups had no statistical difference. The number of press analgesic pump, the sulfentanyl consumption, and the first pressing time of the analgesic pump had no statistical difference either. There was no significant difference in adverse reaction in both groups.
Conclusion Both ultrasound-guided MTPB or TPVB combined with postoperative PCIA were effective for perioperative analgesia in uVATS. However, MTPB is simple and safe, and can be used as an option for postoperative analgesia in uVATS.
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