超声引导下竖脊肌阻滞对胸腔镜肺癌根治术患者术后镇痛的效果观察

目的观察超声引导下竖脊肌阻滞对胸腔镜肺癌根治术患者术后镇痛的效果。方法择期胸腔镜肺癌根治术患者150例,采用随机数字表法分为2组,神经阻滞组(N组)和PCIA组(P组)。N组在麻醉开始前对患者进行超声引导下竖脊肌阻滞;P组在手术结束后连接PCIA泵,药物配方为舒芬太尼100μg+昂丹司琼8 mg。记录术后4、12、24、48 h的静息和活动VAS疼痛评分,补救镇痛次数以及神经阻滞相关并发症等。结果与P组比较,N组术后4～24 h静息和活动VAS评分均明显降低,并且补救镇痛曲马多的用量更少,术后3天内,每天的最大疼痛评分均更低(P<0.05)。术后48 h内未发生穿刺部位出血、感染及局麻药不良反应;N组发生恶心呕吐3例(4.0%),P组发生恶心呕吐19例(25.3%),N组术后48 h内恶心呕吐的发生率明显低于P组(P<0.05)。结论超声引导下竖脊肌阻滞对胸腔镜肺癌根治术患者术后镇痛效果良好,不良反应小,可以作为术后镇痛的方法。

Effect of Ultrasound-guided Spinal Muscle Block on Postoperative Analgesia in Patients with Thoracoscopic Radical Resection of Lung Cancer

Objective To observe the effect of ultrasound-guided spinal muscle block on postoperative analgesia in patients with thoracoscopic radical resection of lung cancer.Methods 150 patients with lung cancer underwent thoracoscopic radical resection were randomly divided into 2 groups:nerve block group(N Group)and PCIA group(P group).Group N received ultrasound-guided spinal muscle block before anesthesia,group P was connected with PCIA pump after operation,and the drug formula was sufentanil 100μg+ondansetron 8 mg.The rest and activity VAS pain scores,times of rescue analgesia and complications related to nerve block were recorded at 4,12,24 and 48 hours after operation.Results Compared with group P,rest and activity VAS pain scores were lower,and dose of rescue analgesia with Tramadol was less,The biggest pain score was lower every day(P<0.05).There had no puncture site of bleeding,infection and local anesthetic toxicity reaction postoperative 48h;Nausea and vomiting occurred in 3 cases(4.0%)in group N and 19 cases(25.3%)in group P.Compared with group P,the incidence of nausea and vomiting in group N was significantly lower than that in group P(P<0.05).Conclusion Ultrasound guided spinal muscle block has good analgesic effect and less adverse reactions in patients with thoracoscopic radical resection of lung cancer,which can be used as a method of postoperative analgesia.