超声引导下椎旁阻滞在开胸手术后镇痛的临床应用

乔飞; 汪珺; 展希; 杨文燕

超声引导下椎旁阻滞在开胸手术后镇痛的临床应用

昆明医科大学第一附属医院麻醉科

基金项目:

基金：贝朗麻醉科学研究基金资助项目 (BBDF-2015-010);

计量
- 文章访问数: 2473
- HTML全文浏览量: 866
- PDF下载量: 76
- 被引次数: 0
出版历程
- 收稿日期: 2017-02-17

Clinical Application of Ultrasound-guided Paravertebral Nerve Block in Analgesia after Thoracotomy

Funds:

基金：贝朗麻醉科学研究基金资助项目 (BBDF-2015-010);

摘要

摘要: 目的探讨超声引导下椎旁神经阻滞在开胸手术术后的镇痛效果.方法 ASAⅠⅡ级, 全身麻醉下行择期开胸手术患者70例, 随机分为胸椎旁神经阻滞复合全麻组 (T组, n=35) 和单纯全身麻醉组 (G组, n=35) .T组患者于全麻诱导前在超声引导下行开胸侧切口所在胸椎旁间隙注射0.5%罗哌卡因0.25 m L/kg.所有患者术后均使用静脉自控镇痛泵.记录两组患者麻醉前、术后6 h、12 h、24 h、48 h的心率 (HR) 、平均动脉压 (MBP) 、吸空气状态下氧饱和度 (SpO2) 值及安静及咳嗽时视觉模拟疼痛评分 (VAS) 和镇痛泵按压总次数、相关并发症, 以及术后首次进食时间和首次下床时间.结果与T组比较, G组患者术后6 h、12 h、24 h时的HR、MBP增高, 安静及咳嗽时VAS评分明显降低 (P<0.05) , 镇痛泵按压次数明显减少 (P<0.05) ;T组患者术后恶心、呕吐减少, 术后首次进食时间及下床时间缩短 (P<0.05) .结论超声引导下行胸椎旁神经阻滞定位准确, 效果确切, 用于开胸手术患者可有效减轻术后疼痛, 不良反应少, 有利于患者早期康复, 是目前开胸手术术后镇痛较为理想的一种方法.
- 超声引导 /
- 椎旁神经阻滞 /
- 开胸术后镇痛
Abstract: Objective To observe the analgesic effect of ultrasound-guided paravertebral nerve block on analgesia after thoracotomy. Me thods 70 patients who were in ASA Ⅰ ~ Ⅱ and planned to undergo elective thoracotomy surgery with tracheal intubation anesthesia were randomly divided into two groups (Group T and Group G) of 35 cases each. Patients in group T received paravertebral injection of 0.5% of pivocaine under ultrasound guide before induction. Postoperative intravenous self-control analgesia pump was used in all patients. The patients' heart rate (HR) and mean arterial pressure (MAP) and Oxygen saturation air condition (Sp O2) were recorded in different moments. The visual analog scale (VAS) scores were recorded at 6, 12, 24 and 48 h after operation.Frequency for compress PCA, related complications, the first eating time and the leaving bed time after operation were recorded as well. Re s ults At 6, 12 and 24 h after operation, the change in HR, MAP and VAS scale of Group T varied within a smaller range than Group G (P<0.05) . The PCA numbers, postoperative nausea and vomiting were significantly less in group P than those in group G (P<0.05) .The time of the first eating and the leaving bed after operation was shorten in Group T than in Group G (P <0.05) . Conclus ion Thoracic paravertebral block by ultrasound guide is accurate and effective for elective thoracotomy patient, can effectively reduce postoperative pain, less adverse reaction, is beneficial to patients with early rehabilitation, is the ideal for postoperative analgesia after thoracotomy.
- Ultrasound guid /
- Paravertebral never block /
- Post-thoracotomy analgesia

HTML全文

参考文献(15)

[1]施贞, 李居宸, 江晓菁.开胸手术后连续椎旁阻滞和硬膜外阻滞镇痛效果比较的系统评价[J].中国循证医学杂志, 2015, 15 (5) :550-558.
[2]	[2]PINTARIC T S, POTOCNIK I, HADZIC A, et al.Comparison of continuous thoracic epidural with paravertebral block on perioperative analgesia and hemodynamic stability in patients having open lung surgery[J].Reg Anesth Pain Med, 2011, 36 (3) :256-260.
[3]	[3]WARMAN P, NICHOLLS B.Ultrasound-guided nerve blocks:efficacy and safety[J].Best Pract Res Clin Anaesthesiol, 2009, 23 (3) :313-326.
[4]	[4]ENG H C, GHOSH S M, CHIN K J.Practical use of local anesthetics in regional anesthesia[J].Curr Opin Anaesthesiol, 2014, 27 (4) :382-387.
[5]	[5]KOYYALAMUDI V B, ARULKUMAR S, YOST B R, et al.Supraclavicular and paravertebral blocks:Are we underutilizing these regional techniques in perioperative analgesia[J].Best Pract Res Clin Anaesthesiol, 2014, 28 (2) :127-138.
[6]	[6]YOSHIDA T, FUJIWARA T, FURUTANI K, et al.Effects of ropivacaine concentration on the spread of sensory block produced by continuous thoracicparavertebral block:a prospective, randomised, controlled, double-blind study[J].Anaesthesia, 2014, 69 (3) :231-239.
[7]	[7]MATYAL R, MONTEALEGRE-GALLEGOS M, HNIDER M, et al.Preemptive ultrasound-guided paravertebral block and immediate postoperative lung function[J].Gen Thorac Cardiovasc Surg, 2015, 63 (1) :43-48.
[8]	[8]BERDE C B, BORETSKY K R, CRAVERO J P.Paravertebral block for analgesia after pediatric thoracic surgery[J].Reg Anesth Pain Med, 2014, 39 (3) :179-180.
[9]	[9]BORETSKY K, VISOIU M, BIGELEISEN P.Ultrasoundguided approach to the paravertebral space for catheter insertion in infants and children[J].Paediatr Anaesth, 2013, 23 (12) :1193-1198.
[10]	[10]CUTSHALL C, HUTCHINS J.Ultrasound-guided continuous thoracic paravertebral catheter management of acute rib pain secondary to cystic fibrosis exacerbation in a pediatric patient[J].A Case Rep, 2015, 14 (3) :29-30.
[11]	[11]ZHANG W, FANG C, LI J, et al.Single-dose, bilateral paravertebral block plus intravenous sufentanil analgesia in patients with esophageal cancer undergoing combined thoracoscopic-laparoscopic esophagectomy:a safe and effective alternative[J].J Cardiothorac Vasc Anesth, 2014, 28 (4) :978-984.
[12]	[12]TAHIRI Y, TRAN D Q, BOUTEAUD J, et al.General anaesthesia versus thoracic paravertebral block for breast surgery:a meta-analysis[J].J Plast Reconstr Aesthet Surg, 2011, 64 (10) :1261-1269.
[13]	[13]OKAJIMA H, TANAKA O, USHIO M, et al.Ultrasoundguided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery[J].J Anesth, 2014:15 (3) :273-379.
[14]何建华, 马曙亮, 顾连兵.超声引导椎旁神经阻滞在开胸手术中的应用[J].临床麻醉学杂志, 2013, 29 (1) :31-34.
[15]	[15]BAIK J S, OH A Y, CHO C W, et al.Thoracic paravertebral block for nephrectomy:a randomized, controlled, observer-blinded study[J].Pain Med, 2014, 15 (5) :850-856.

相关文章(20)

[1]	毛健宇, 陈建军, 阎静楠, 王泉, 詹力, 李石乔, 保文莉. 超声引导下肋间神经脉冲射频治疗胸椎高节段带状疱疹后神经痛的临床疗效, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240514
[2]	杨云丽, 李娜, 邱昌明, 普俊杰, 聂维, 李治贵. 超声引导下前路腰方肌阻滞对髋关节手术患儿术后镇痛效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230426
[3]	陆贤松, 郭冬妍, 乔飞. 超声引导下椎旁、竖脊肌、前锯肌平面阻滞在胸科手术中的镇痛平面比较, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221226
[4]	鲁月, 邱昌明, 杨云丽, 黄治国, 李治贵, 麻伟青, 李娜. 超声引导下右美托咪定作为佐剂的罗哌卡因单次收肌管阻滞用于成人髌骨骨折术后镇痛的效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220613
[5]	杨皓, 张国云, 王德财, 郭云瑞, 张业才, 杨建明. B超引导下股神经阻滞镇痛和口服镇痛在老年股骨中上段骨折术前镇痛中的应用效果, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210931
[6]	韦琳, 冯煜然, 袁惠, 周科宇, 赵诣, 钱军, 朱梅. 超声引导下甲状腺结节细针穿刺活检的6种操作方法的比较, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211044
[7]	陈竹梅, 华月英, 温艳艳, 李辉. 行超声引导下PICC置管患者并发症的发生情况及影响因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210209
[8]	周银燕, 张宇, 白文娅, 沈艳娟, 邵建林, 赵国良. 直视下胸椎旁神经阻滞对胸科手术患者术后镇痛效果的影响, 昆明医科大学学报.
[9]	刘少星, 谢先丰, 曹德钧. 不同镇痛模式在幼儿疝气修补术后早期镇痛的临床效果, 昆明医科大学学报.
[10]	王兴耀, 钱金桥. 超声引导单点和双点椎旁神经阻滞在胸腔镜术患者的镇痛比较, 昆明医科大学学报.
[11]	王炯, 张先政. 胸椎旁神经阻滞与全身麻醉对肺癌根治术患者肺氧合功能、术后疼痛及认知功能的影响, 昆明医科大学学报.
[12]	高静, 李英华, 袁媛, 吴仕葱. 超声引导下微波消融术治疗甲状腺良性结节临床效果, 昆明医科大学学报.
[13]	刘明敏, 王丽春, 梁喜, 杨蕊. 超声引导下乳腺微小病变活检应用于乳腺癌早期诊断, 昆明医科大学学报.
[14]	李蕊, 魏鲁刚, 杨艳, 张林森, 张洪秀. 脑卒中低肌张力患者超声引导下外周神经电刺激的临床对照, 昆明医科大学学报.
[15]	李星, 梁红敏, 朱梅, 何敏, 曹维涵. 超声引导下星状神经节阻滞治疗失眠症疗效和安全性评价, 昆明医科大学学报.
[16]	魏辉明, 王玲玲, 邱昌明, 李文锋, 麻伟青. 超声引导环甲膜穿刺气道表麻对经鼻气管插管反应的影响, 昆明医科大学学报.
[17]	张灿华, 钱金桥. 超声引导下外周神经阻滞麻醉对老年人下肢骨科术后功能恢复的影响, 昆明医科大学学报.
[18]	庞佳宁, 刘劲松, 李溪, 王莉竹, 张锡华. TKA术后连续股神经阻滞早期镇痛疗效, 昆明医科大学学报.
[19]	陈永伦. 椎旁神经阻滞复合全麻在胸科手术中的应用, 昆明医科大学学报.
[20]	李明. 超声引导联合神经刺激器在上肢臂丛神经阻滞的临床研究, 昆明医科大学学报.