超声引导下胸椎旁神经阻滞在胸科手术中的应用

摘要

Objective To explore the application of ultrasound-guided thoracic paravertebral blockade (TPVB) in thoracic surgery. Methods Seventy patients undergoing selective unilateral open thoracic surgery were assigned to observation and control group of 35 ones each according to random number table. Control group received traditional blind TPVB,the observation did ultrasound-guided TPVB,and group TPVB achievement ratios,maximal blockade surfaces,mean arterial blood pressures (MAP) and heart rates (HR),fentanyl dosages and pressing frequencies of postoperative analgesia pump were compared. Results TPVB achievement ratio was respectively 100% in observation and 82.9% in control group,the former significantly higher than the latter (P<0.05). Maximal blockade surfaces were significantly larger (P<0.01) and MAPs and HRs when skin incision and placing sternum dilator (P<0.01) as well as fentanyl dosages and pressing frequencies of postoperative analgesia pump lower (P<0.01) in observation than in control group. Conclusion Ultrasound-guided TPVB has higher accuracy and safety and better analgesia effect and deserves clinical generalization and application.%目的 探讨超声引导下胸椎旁神经阻滞在胸科手术中的应用.方法 将70例择期行单侧开胸手术的患者采用随机数字表法分为观察组与对照组,每组35例.对照组采用传统盲探法进行胸椎旁阻滞,观察组在超声引导下行胸椎旁阻滞,比较两组胸椎旁阻滞的成功率、最大阻滞平面、各时间点平均动脉压与心率、芬太尼用量、术后镇痛泵按压次数.结果 观察组胸椎旁阻滞的成功率为100%,对照组为82.9%,观察组显著高于对照组(P<0.05).观察组最大阻滞平面显著高于对照组(P<0.01),在切皮时与放置胸骨撑开器时平均按压动脉压与心率均显著低于对照组(P<0.01),芬太尼用量与术后镇痛泵按压次数均显著低于对照组(P<0.01).结论 超声引导下胸椎旁神经阻滞准确性及安全性高,镇痛效果较好,值得临床推广应用.