摘要
目的观察胸腔镜直视下椎旁阻滞在胸科手术术后镇痛中的应用。方法选取120例胸腔镜下肺叶切除术患者,数字表法分为对照组和观察组,每组60例。观察组手术结束前在胸腔镜直视下胸3-4和胸5-6椎间隙旁注射0.375%罗哌卡因,各10 ml;对照组注入等量生理盐水。观察术后2、6、12、24、48 h的静息、运动VAS评分和Ramsay镇静评分,并于上述各时点抽取静脉血检测血清IL-6、IL-10和TNF-α浓度。记录两组不良反应发生比例、镇痛按压次数和追加镇痛药物量,记录两组术后首次下床活动时间、拔除胸腔引流管时间和术后住院天数。结果与对照组比较,观察组术后静息和运动VAS评分低,Ramsay镇静评分高;术后2、6、12、24 h血清IL-6和TNF-α浓度低,血清IL-10浓度高;镇痛按压次数、追加镇痛药物量、不良反应发生比例少,术后首次下床活动时间、拔除胸腔引流管时间和术后住院天数短,差异均有统计学意义(均P<0.05)。结论胸腔镜直视下椎旁阻滞操作简单,可有效减轻胸科手术术后疼痛,减轻患者炎症反应,减少术后镇痛药物使用,降低不良反应,促进术后恢复。
Objective To observe the effects of thoracoscopic paravertebral block for analgesia after video-assisted thoracic surgery.Methods 120 patients receiving video-assisted thoracic surgery were randomly and equally divided into control group and observation group,60 patients respectively.Patients in observation group were given thoracic paravertebral block with 0.375%ropivacaine 10ml between the thoracic segments T3-4 and T5-6 with thoracoscope-guided at the end of surgery,while the control group was given equal saline.To observe the visual analogue scale(VAS)and Ramsay sedation scale at 2 h,6 h,12 h,24 and 48 h after the operation.The vein blood were sampled for TNF-α,interleukin-6 and interleukin-10 at thoese time points.To observe the adverse reaction,the times pressing the analgesic pump button and the addition of analgesics.To observe the time of getting out of bed,removing thoracic drainage tube and the postoperative hospital stay.Results The VAS score of observation group were lower than control group(P<0.05).The Ramsay sedation scal of observation group were higher than control group(P<0.05).The adverse reaction,the times pressing the analgesic pump button and the addition of analgesics of observation group were lower than control group(P<0.05).The TNF-αand IL-6 of observation group were significantly lower than control group at 2 h,6 h,12 h and 24 h after the operation,the IL-10 of observation group were significantly higher than control group at 2 h,6 h,12 h and 24 h after the operation(P<0.05).The time of getting out of bed,removing thoracic drainage tube and the postoperative hospital stay of observation group were significantly lower than control group(P<0.05).Conclusion Thoracoscopic paravertebral block is easy to operate,which can effectively alleviate the postoperative pain of thoracic surgery,reduce the inflammatory response,use of analgesics and adverse reactions,and promote postoperative recovery.
作者
胡礼宏
徐霞
贺靳贤
朱曼华
Hu Lihong;Xu Xia;He Jinxian;Zhu Manhua(Department of Anesthesiology,Ningbo Medical Center Lihuili Hospital(Eastern Branch),Ningbo 315040,China;Department of Anesthesiology,Ningbo Medical Center Lihuili Hospital(Xingning Branch),Ningbo 315040,China;Department of Thoracic Surgery,Ningbo Medical Center Lihuili Hospital(Eastern Branch),Ningbo 315040,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2020年第12期757-760,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
宁波市科技创新2025重大专项(2019B10039)。
关键词
胸腔镜
胸科手术
椎旁阻滞
术后镇痛
Thoracoscopic
Thoracic surgery
Paravertebral block
Postoperative analgesia
