超声引导胸椎旁神经阻滞在胸腔镜肺叶切除术中应用的临床观察研究

目的:探讨超声引导胸椎旁神经阻滞与胸段硬膜外麻醉在胸腔镜肺叶切除术患者中的应用效果。方法:选择择期行胸腔镜肺叶切除术的患者52例,随机分为两组:胸段硬膜外麻醉组(E组,n=26)和超声引导椎旁神经阻滞组(P组,n=26)。记录并比较两组患者术中液体用量,舒芬太尼累积用量,血管活性药用量,术后6、12、24、36、48、72 h六个时间点安静和深呼吸时的视觉模拟评分(VAS),拉姆齐镇静评分(RSS),术后恶心呕吐次数,不良反应发生率等。结果:(1)两组术中舒芬太尼累积用量和液体用量无明显差异,但E组麻醉时长和血管活性药应用比例大于P组,女性患者比例小于P组(P<0.05);(2)术后6 h、12 h,P组的动态VAS评分均低于E组(P<0.05);(3)所有时间点,两组的静态VAS评分差异均无统计学意义;(4)术后6 h、24 h,P组的RSS评分全部大于E组(P<0.05);(5)P组的穿刺点外渗比例小于E组,干呕比例大于E组,差异有统计学意义(P<0.05)。结论:VATS肺叶切除术后患者采用超声引导椎旁神经阻滞联合静脉自控镇痛与硬膜外镇痛效果相当,且操作简单、不良反应少。

Clinical Investigation of Ultrasound-guided Thoracic Paravertebral Nerve Block for Patients Following Video-Assisted Thoracic Surgery Lobectomy

Objective To compare the analgesic effect and the incidence of complications between TPVB and TEA in Video-assisted Thoracic Surgery (VATS). Methods 52 patients undergoing VATS lobectomy were randomly divided into two groups: thoracic epidural group(group E, n =26)and ultrasound-guidedthoracic paravertebral nerve block group (group P, n =26).Intraoperative fluid consumption, sufentanilcumulative consumption and vasopressor consumption were recorded. The Visual Analog Scale (VAS) score at deep breath and rest, Ramsey Sedation Scale(RSS), Post Operative Nausea And Vomiting (PONV)times, side effects and overall patient satisfaction were measured at the time points of 6 h(T1), 12 h(T2), 24 h(T3), 36 h(T4), 48h(T5) and 72 h(T6)after surgery during three days'' follow-up. Results There was no difference in sufentanil cumulativedosage and liquid dosage between the two groups during operation, but the durationand the using of vasoactive drugs in group E were more than those in group P. There were significant differences in dynamic VAS score between the two groups at T1 and T2 time points after operation.There was no statistically significant difference between two groups in the VAS score in all time points. There was significant differences (P =0.023) towards the level of sedation between the two groups from 6 h to 12 h postoperatively, which Group P has deeper RSS scores than group E in all time points. However the incidence of dizziness is significantly high in group P. Conclusion Preemptive ultrasound-guidedthoracic paravertebral block combining with PCIA can provide comparable analgesia to thoracic epidural analgesia without significant adverse effects.