摘要
目的探讨胸腔镜直视下肋间神经阻滞(ICB)与超声引导下胸椎旁神经阻滞(TPVB)在单孔胸腔镜肺切除手术中的应用价值.方法96例行单孔胸腔镜肺手术患者按照随机数字表法分为TPVB组、ICB组和自控静脉镇痛组(PCIA)组,每组各32例.TPVB组在超声引导连续胸椎旁神经阻滞镇痛联合PCIA静脉镇痛,ICB组在胸腔镜直视下行ICB联合PCIA静脉镇痛,PCIA组只采取静脉镇痛.观察并记录三组的手术一般情况、术后48h内的疼痛VAS评分以及并发症发生情况.结果TPVB组拔除引流管的时间短于PCIA组和ICB组.术后48h内,ICB组与TPVB组患者在静息和咳嗽时的疼痛VAS评分明显降低,与PCIA组相比差异有统计学意义(P<0.05);TPVB组的VAS评分低于ICB组,但部分有统计学差异(P<0.05).TPVB组操作所需时间为(14.5±2.1)min,明显长于ICB组(2.5±0.5)min.PCIA组,2例(6.25%)发生肺不张,1例(3.13%)发生心律失常;ICB组,1例(3.13%)发生肺部感染;TPVB组,4例(12.50%)可见胸壁血肿.三组患者术后发生恶心、呕吐的例数比较,差异均无统计学意义(P>0.05).结论单孔胸腔镜肺手术应用肋间神经阻滞与超声引导下椎旁神经阻滞联合PCIA镇痛的术后镇痛效果优于单纯采用PCIA镇痛,且操作方便.
Objective To investigate the application value of thoracoscopic visual intercostal nerve block(ICB)and ultrasound-guided thoracic paraspinal nerve block(TPVB)in single-port thoracoscopic pulmonary surgery.Methods 96 patients undergoing single-port thoracoscopic pulmonary surgery were divided into TPVB group,ICB group and PCIA group according to random number table,with 32 cases in each group.In the TPVB group,ultrasound guided continuous thoracic paraspinal nerve block analgesia combined with PCIA intravenous analgesia.In the ICB group,ICB combined with PCIA intravenous analgesia under thoracoscopic direct vision.In the PCIA group,only intravenous analgesia was adopted.General operation,VAS score and complications within 48 h after operation were observed and recorded in the three groups.Results The drainage tube removal time of TPVB group was shorter than that of PCIA group and ICB group.Within 48 h after surgery,the PAIN VAS score of ICB group and TPVB group at rest and cough was significantly decreased,and the difference was statistically significant compared with PCIA group(P<0.05).VAS score of TPVB group was lower than that of ICB group,but some differences were statistically significant(P<0.05).The operation time of TPVB group was(14.5±2.1)min,which was significantly longer than that of ICB group(2.5±0.5)min.In PCIA group,2 patients(6.25%)developed atelectasis and 1 patient(3.13%)developed arrhythmia.In ICB group,1 case(3.13%)developed pulmonary infection.In TPVB group,4 cases(12.50%)had chest wall hematoma.There was no statistical significance in the number of postoperative nausea and vomiting among 3 groups(P>0.05).Conclusion Intercostal nerve block and ultrasonic-guided paravertebral nerve block combined with PCIA analgesia have better postoperative analgesia effect in single port thoracoscopic pulmonary surgery than PCIA analgesia alone,and the operation is convenient.
出处
《浙江临床医学》
2022年第1期89-91,共3页
Zhejiang Clinical Medical Journal
关键词
胸腔镜
单孔
胸椎旁神经阻滞
肋间神经阻滞
术后镇痛
Thoracoscope
Single port
Thoracic paraspinal nerve block
Intercostal nerve block
Postoperative analgesia
