超声引导下胸椎旁神经阻滞在开放性肾切除手术中的临床应用

摘要

Objective To investigate the effect of ultrasound-guided thoracic paravertebral block in patient undergoing open nephrectomy. Methods Sixty patients undergoing elective open nephrectomy were randomly divided into two groups. The patients in group T were given the general anesthesia combined with ultrasound-guided thoracic paravertebral block , and the patients in group G were given only general anesthesia. Both groups received postoperative patient controlled intravenous analge-sia. 20ml injection of 0.5%ropivacaine was administered preoperatively under ultrasound guidance in group T. The hemodynam-ics, remifentanil dosage during operation and time in post anesthesia care unit were recorded. The analgesic effect was measured by VAS pain scores at 1h(T5),4h(T6),8h(T7),12h(T8),24h(T9),36h(T10) after surgery. Results The fluctuation in HR and MAP after skin incision of group T was less than that of group G. The total dosage of remifentanil and time in PACU of group T was less than that of group G. The VAS scores at T5~T9 after surgery were significantly lower in group T than group G. Conclusion General anesthesia combined with ultrasound-guided thoracic paravertebral block can offer sufficient postopera-tive analgesia,and reduce remifentanil consumption in patient undergoing open nephrectomy.%目的：观察超声引导下胸椎旁神经阻滞对开放性肾切除术患者麻醉效果的影响。方法选择择期全身麻醉下行开放性肾脏切除术的患者60例，ASAⅠ或Ⅱ级，随机分为胸椎旁神经阻滞复合全身麻醉组（T组，n＝30）和单纯全身麻醉组（G组，n＝30）。 T组患者全麻诱导前行超声引导下胸椎旁神经阻滞，单次给予0.5%罗哌卡因20ml，两组患者均采用相同的全身麻醉方法。两组患者术后均采用静脉自控镇痛。记录注药前（T0）、插管前（T1）、气管插管即刻（T2）、手术开始时（T3）、术毕时（T4）的MAP、HR，记录瑞芬太尼的用量，记录患者在麻醉恢复室停留时间，记录术后1h（T5）、4h（T6）、8h（T7）、12h（T8）、24h（T9）、36h（T10）时VAS评分。结果 G组较T组患者手术开始时MAP、HR波动更为明显（P<0.05），其余时间点MAP、HR比较，差异无统计学意义。G组患者术中瑞芬太尼用量大于T组，PACU停留时间明显长于T组（P<0.05），术后T组患者T5~T9时VAS评分均明显低于G组（P<0.05），T10时两组患者VAS评分差异无统计学意义。结论超声引导下胸椎旁神经阻滞复合全身麻醉用于肾脏切除手术能够提供更好的术后镇痛，减少术中全麻药物的用量。