胸腔镜直视下椎旁阻滞在胸腔镜下肺叶切除术术后镇痛中的应用

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摘要目的: 探讨胸腔镜直视下椎旁阻滞在胸腔镜下肺叶切除术术后镇痛的效果。方法：选取2019年5月至12月我院收治的行胸腔镜下肺叶切除术患者80例，美国麻醉协会（American Society of Anesthesiologists，ASA）分级Ⅱ-Ⅲ级，采用随机数字表法分为对照组和椎旁阻滞组，每组40例。对照组术毕采用静脉自控镇痛（patientcontrolled intravenous analgesia , PCIA）；椎旁阻滞组手术结束前行胸腔镜直视下多点椎旁神经阻滞（T4-5和T8-9间隙），术毕联合PCIA。记录术后动态VAS评分，镇痛泵按压次数、镇痛满意例数、镇痛补救例数以及术后恶心呕吐、头晕和术后谵妄等不良反应情况。结果：与对照组比较，椎旁阻滞组患者动态VAS评分明显降低；PCIA按压次数明显减少；需要镇痛补救的例数降低；患者术后满意例数增多。而且，椎旁阻滞组患者术后恶心呕吐和头晕的发生率明显低于对照组。结论：胸腔镜直视下椎旁阻滞联合术后PCIA可有效缓解胸腔镜肺叶切除术患者术后疼痛，减少术后镇痛药的应用，降低术后不良反应的发生率。

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	柯品辉
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关键词 ：术后镇痛, 胸腔镜手术, 胸椎旁阻滞, 不良反应, VAS评分

Abstract：Objective: To evaluate the analgesic effects of thoracoscopic paravertebral block ,which used videoassisted thoracic for analgesia after thoracoscopic lobectomy. Methods: A total of 80 patients, who were treated by thoracoscopic lobectomy in Putian First Hospital from May to December 2019, and as American Society of anesthesiologists （ASA） class Ⅱ-Ⅲ were enrolled in the study. They were divided into control group and paravertebral block （PVB） group randomly and equally, 40 patients, using a random number table. Patients in control group were given patientcontrolled intravenous analgesia （PCIA） after operation. Patients of PVB group anesthetics were injected into the thoracic 4-5 and 8-9 intercostal at the end of surgery combined with PCIA after operation. Postoperative visual analogue scale （VAS） score, the times pressing analgesia pump button, the satisfactory of analgesia, the needs for rescue analgesia were recorded. In addition, the occurence of nausea, vomiting and dizziness and delirium were recorded after surgery. Results: Compared with control group, the VAS score of PVB group were significantly reduced, the times pressing analgesia pump button were decreased, the needs for rescue analgesia were also dropped, the satisfactory of analgesia were increased. Moreover, the incidence of postoperative nausea, vomiting and dizziness in PVB group were significantly lower than that in control group. Conclusion: Thoracoscopic paravertebral block, using videoassisted thoracic combined with PCIA after surgery can effectively alleviate the postoperative pain of thoracic surgey, reduce the reuse of analegsics and the incidence of postoperative adverse reactions.

收稿日期: 2021-05-17

通讯作者: 喻耀华（通讯作者），副主任医师，E-mail：yyh.8@163.com

作者简介: 柯品辉（1988—），男，主治医师，主要从事临床麻醉与镇痛等方面的研究；

引用本文:

柯品辉，林良青，吴清华，喻耀华. 胸腔镜直视下椎旁阻滞在胸腔镜下肺叶切除术术后镇痛中的应用[J]. 江苏大学学报:医学版, 2021, 31(05): 417-420. KE Pinhui, LIN Liangqing, WU Qinghua, YU Yaohua.

Application of thoracoscopic paravertebral block in analgesia after thoracoscopic lobectomy

. Journal of Jiangsu University(Medicine Edition), 2021, 31(05): 417-420.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2021/V31/I05/417

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