胸腔镜肺叶切除术后病人胸椎旁阻滞的镇痛效果

目的 评价胸腔镜肺叶切除术后病人胸椎旁阻滞的镇痛效果.方法 择期行单侧胸腔镜肺叶切除术病人50例,性别不限,ASA分级Ⅰ或Ⅱ级,年龄20～76岁,身高152～183 cm,体重45～90 kg,随机分为2组(n=25),PVB组在气管插管后行手术侧T7,8椎旁间隙穿刺置管.Ⅳ组于手术结束前30 min静脉注射舒芬太尼0.1μg,/kg负荷量,术毕时进行病人自控静脉镇痛,镇痛药物为舒芬太尼1.0μg/ml,背景输注速率2.0ml/h,PCA量2.0ml,锁定时间15 min;PVB组于手术结束前30min经椎旁间隙导管注射0.5%罗哌卡因20 ml负荷量,术毕时进行病人自控镇痛,镇痛药物为0.2%罗哌卡因,PCA量8.0 ml,锁定时间30 mirn.分别于拔除气管导管后30 min(T1)、术后24 h(T2)、48 h(T3)和72 h(T4)时记录数字等级评分(NRS评分).监测血液动力学指标和SpO2.分别于术前(基础状态)及术后拔除胸腔闭式引流管后30 min记录呼吸功能指标.分别于术前(基础状态)、T1、T2和T4时采集静脉血样,测定全血皮质醇和血糖的浓度.记录镇痛补救情况及术后不良反应的发生情况.结果 与Ⅳ组比较,PVB组血液动力学指标、SpO2、静息时NRS评分、镇痛补救率和术后不良反应发生率差异无统计学意义(P＞0.05),咳嗽时NRS评分、皮质醇浓度和血糖浓度降低,术后第1秒用力呼气量升高(P＜0.05).结论 胸腔镜肺叶切除术后病人胸椎旁阻滞的镇痛效果好,安全性良好.

Analgesic efficacy of thoracic paravertebral block after lobectomy performed via video-assisted thoracoscope

Objective To evaluate the analgesic efficacy of thoracic paravertebral block (PVB) in patients after lobectomy performed via video-assisted thoracoscope (VAT) .Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 45-90 kg undergoing elective lobectomy via VAT were randomly divided into 2 groups (n = 25 each): patient-controlled intravenous analgesia (PCIA) group and thoracic PVB group. PVB was performed according to the method described by Jamieson et al and Richardson et al. Paravertebral catheter was placed at T7-8 after induction of anesthesia and tracheal intubation. A loading dose of 0.5% ropivacaine 20 ml was administered via PVB catheter at 30 min before the end of operation. PVB was then controlled by the patients with 0.2% ropivacaine (bolus dose 8.0 ml, lockout interval 30 min). In PCIA group a loading dose of sufentanil 0.1 μg/kg was given iv at 30 mln before the end of operation. Sufentanil 1.0 μg/ml was used. PCIA included a bolus of 2 ml with a 15 min lockout interval and background infusion 2 ml/h. Numeric rating scale (NRS) (0=no pain, 10 = most severe pain) was used to assess the intensity of pain. NRS score, MAP, HR and SpO2 were recorded before operation (T0 ,baseline), 30 min after withdrawal of chest tube (Ti) and at 24, 48 and 72 h after operation (T2, T3, T4). Forced vital capacity (FVC) and forced expiratory volume first second (FEV1.0) were measured and FVC/FEV1.0 ratio was calculated after chest tube was withdrawn. Blood cortisone and glucose concentrations were determined at To, T1 and T4. Requirement for rescue analgesics and side effects were recorded. Results There was no significant difference in MAP, HR, SpO2 and NRS at rest between the 2 groups.NRS at coughing and blood cortisone and glucose concentrations were significantly lower and the postoperative FEV1.0 was significantly higher in PVB group than in PCIA group. The requirement for rescue analgesics and side effects were comparable between the 2 groups. Conclusion Thoracic PVB can provide better postoperative analgesia with little side effects.