超声引导下竖脊肌平面阻滞与胸椎旁神经阻滞用于胸腔镜术后镇痛比较

摘要

Objective To investigate the analgesic effect of ultrasound-guided vertical spinal block (ESPB) in elderly patients after thoracoscopic surgery.Methods 40 elderly patients,aged 60-75 years,were selected for selective thoracoscopic surgery.Patients were randomly divided into two groups,ESPB group (E group) and paravertebral block (PVB) group (P group).In the E group,0.33％ ropivacaine 30 ml was injected between the T5 vertebral body transverse and the erector spines before surgery,and 0.33％ ropivacaine 30 ml was injected into the thoracic paravertebral space of T5-T6 in the P group.Patients in both groups were treated with sufentanil for postoperative patient controlled analgesia (PCA).The dosage of remifentanil intraoperative and sufentanil postoperative,remedial cases recorded in post anesthesia care unit (PACU),numeric rating scale (NRS) score at postoperative 1 h,6 h,12 h and 24 h were recorded,and intraoperative hypotension,postoperative nausea and vomiting cases,and operation time were documented.Results There was no significant difference in remifentanil dosage between the two groups (P ＞ 0.05).The total consumption of sufentanil in group E 24 hours after operation was higher than that in group P (P ＜ 0.05).The operation time of ultrasound-guided nerve block in group E was shorter than that in group P (P ＜ 0.05).The number of PACU remedial cases in group E was higher than that in group P (P ＞ 0.05).The NRS score recorded at postoperative 1 h,6 h,12 h and 24 h show no difference.There was no significant difference in the incidence of nausea and vomiting and intraoperative hypotension in the two groups.Conclusions Ultrasound-guided single ESPB block provides postoperative analgesia,which is similar but weaker compared with PVB and easy to operate.%目的 探讨超声引导下竖脊肌平面阻滞(ESPB)对老年患者胸腔镜手术后的镇痛作用.方法 选择择期行胸腔镜手术的老年患者40例,ASA Ⅰ～Ⅱ级,年龄60 ～ 75岁.将患者随机分为两组,竖脊肌平面阻滞(ESPB)组(E组)和胸椎旁阻滞(PVB)组(P组).E组术前T5横突与竖脊肌之间予以0.33％罗哌卡因30 ml,P组在T5～T6节段胸椎旁间隙注入0.33％罗哌卡因30 ml.两组患者均使用舒芬太尼进行术后自控镇痛.观察记录术中瑞芬太尼和术后舒芬太尼用量,术后麻醉后监测治疗室(PACU)补救例数,在术后1、6、12、24h进行疼痛数值评分量表(NRS)记录,记录术中低血压的发生和术后恶心呕吐的例数,记录神经阻滞操作时间.结果 两组术中瑞芬太尼用量差异无统计学意义(P＞0.05),E组术后24h舒芬太尼的总消耗量高于P组(P＜0.05),E组超声引导下神经阻滞操作时间短于P组(P＜0.05).E组PACU补救例数多于P组(P＜0.05).两组在术后1、6、12、24h记录的病房NRS评分、恶心呕吐的发生率及术中低血压发生率差异无统计学意义(P＞0.05).结论 超声引导下单次ESPB提供术后镇痛,与PVB相比有相似但较弱的镇痛效果,操作简单易行.