摘要
目的观察超声引导胸椎旁神经阻滞(TPVB)对于肋骨骨折患者术后镇痛效果的影响。方法 40例择期行肋骨骨折切开复位内固定术的患者,随机分为全麻组(GA组,n=20)和全麻联合胸椎旁神经阻滞组(GA+TPVB组,n=20)。GA组接受标准的全身麻醉。在GA+TPVB组,全麻诱导后以0.5%罗哌卡因行患侧超声引导胸椎旁神经阻滞。所有患者在麻醉后恢复室(PACU)开始接受含有舒芬太尼的静脉镇痛泵,术后前3d应用注射用帕瑞昔布钠(特耐)40mg静脉推注,每日2次。记录两组患者术中切皮前后5min平均动脉压(MAP)及心率(HR)变化,术中舒芬太尼的用量;于术后1、12、24、48和72h对患者进行静息和活动下(深呼吸、咳嗽时)疼痛评估,主要预后指标为所有视觉模拟评分法(VAS);记录患者满意度;同时观察术后有无血肿、恶心、呕吐、呼吸抑制等不良反应的发生。结果与GA组比较,GA+TPVB组切皮前后MAP、HR波动明显减小(P<0.05),术中舒芬太尼用量明显减少(P<0.05);两组患者术后1、12、24、48h的VAS有显著差异,与GA组比较,GA+TPVB组VAS明显降低(P<0.05);GA组和GA+TPVB组术后呕吐发生率分别为15%和0,差异有统计学意义(P<0.05)。术后两组患者均未见血肿、呼吸抑制等不良反应发生。结论超声引导胸椎旁神经阻滞定位准确,操作成功率高,明显减少围手术期镇痛药物用量,提供有效的术后镇痛。
Objective To observe the effects of uhrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with rib fracture. Methods Forty patients scheduled for rib fracture internal fixation under general anesthesia were randomly divided into two groups （ n = 20 each ） ：general anesthesia group （ group GA ） and general anesthesia combined with thoracic paravertebral nerve block group （ group GA ＋ TPVB ）. After induction of anesthesia, ultrasound-guided thoracic paravertebral nerve block was performed and 0. 5 % Ropivaeaine was injected in group GA ＋ TPVB ,while nothing was done in group GA. All patients received intravenous analgesia with sufentanil in the PACU. Dynastat 40 mg was injected at two times a day in the first three days after surgery. The hemodynamie parameters during skin incision were recorded. The consumption of sufentanil during operation and VAS score at 1,6,12,24 and 48h after operation were recorded. The adverse reactions were also recorded. Results Compared with group GA, hemodynamic parameters in group GA ＋ TPVB maintained even stable during skin incision （ P 〈 0. 05 ） ; sufentanil consumption was significantly reduced during operation （ P 〈 0. 05 ） ; VAS at 1, 6,12,24 and 48h after operation were significantly lower（P 〈 0. 05 ）. The postoperative vomitting rate in group GA and group GA ＋ TPVB was 15% and 0, respectively. There was no adverse reaction in either groups. Conclusion Ultrasound-guided thoracic paravertebral nerve block can provide accurate positioning, high operation success rate, and effective analgesia. And it can obviously decrease the need for analgesic drugs in perioperative period.
作者
张瑛
陈军
王爱忠
李谦平
成少飞
ZHANG Ying CHEN Jun WANG Ai-zhong LI Qian-ping CHENG Shao-fei(Department of Anesthesiology,East Camp of Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201306,China Department of Cardiothoracic Surgery,East Camp of Sixth People＇s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201306, China)
出处
《创伤外科杂志》
2016年第10期591-594,共4页
Journal of Traumatic Surgery
关键词
肋骨骨折
神经阻滞
超声
镇痛
rib fracture
nerve block
ultrasound
analgesia
