全麻复合胸椎旁阻滞对单孔胸腔镜手术术后疼痛及快速康复的影响

发布时间：2018-03-12 07:30

本文选题：胸椎旁阻滞　切入点：单孔胸腔镜手术　出处：《临床麻醉学杂志》2015年12期 　论文类型：期刊论文

【摘要】：目的探讨全麻复合超声引导下单次胸椎旁阻滞对单孔胸腔镜手术患者术后疼痛和快速康复的影响。方法择期行单孔胸腔镜手术的患者30例,男20例,女10例,采用随机数字表法将患者分为两组,每组15例。C组采用单纯全凭静脉麻醉,T组于麻醉诱导前采用超声引导下单次椎旁神经阻滞,术中行全凭静脉麻醉。两组患者术后均不采用镇痛装置,若术后静息时VAS评分4分,则予单次剂量地佐辛5~20mg,一天最多不超过120mg。记录术后1、4、8、12h的Ramsay镇静评分,术前1d、术后4、8、12、24h的机械痛阈值,术后第1次疼痛反馈时间,术后24h内地佐辛用量及不良反应情况,第1次下床活动时间和术后住院时间。结果与C组比较,T组术后8、12h Ramsay评分明显降低(P0.05),术后4、8h机械痛阈值明显升高(P0.05),第1次疼痛反馈时间明显延长(P0.05),术后24h内地佐辛用量明显减少(P0.05),第1次下床活动时间和住院时间明显缩短(P0.05),术后24h恶心呕吐等不良反应发生率明显降低(P0.05)。结论全麻复合单次胸椎旁阻滞可有效缓解单孔胸腔镜手术患者术后的切口疼痛,减少术后24h内阿片类药物用量,降低不良反应发生,有利于术后早期下床活动,缩短患者住院时间。
[Abstract]:Objective to investigate the effect of general anesthesia combined with ultrasound guidance on pain and rapid recovery of patients undergoing thoracoscopic surgery. Methods Thirty patients (20 males and 10 females) undergoing selective thoracoscopic surgery were enrolled in this study. Patients were randomly divided into two groups: group C (n = 15) received total intravenous anesthesia alone and group T was given an order paravertebral nerve block under ultrasound guidance before anesthesia induction. Total intravenous anesthesia was performed during the operation. No analgesic device was used in both groups. If the VAS score was 4 points at rest, a single dose of dizosin was given at least 120 mg per day, and the Ramsay sedation score of 812 h after operation was recorded. The mechanical pain threshold, the first time of pain feedback, the dosage of Zoxin and the adverse reactions were measured 1 day before operation, 8 minutes after operation and 12 hours after operation, and the time of pain feedback at the first time after operation. Results compared with group C, the Ramsay score of group T decreased significantly at 8h after operation, the threshold of mechanical pain increased significantly at 4h after operation, the time of pain feedback at the first time prolonged P0.05a, and 24 hours after operation, the time of pain feedback in group T was significantly longer than that in group C, and 24 hours after operation, the score of mechanical pain in group T was significantly lower than that in group C, and the threshold of mechanical pain in group T was significantly higher than that in group C. The dosage of P0.05 was significantly reduced, the first time of getting out of bed and the time of hospitalization were shortened obviously, and the incidence of adverse reactions such as nausea and vomiting at 24 hours after operation was obviously reduced. Conclusion General anesthesia combined with single paravertebral block can effectively relieve the single thoracoscopy. Postoperative incision pain, Reducing the dosage of opioid drugs within 24 hours after operation and reducing the occurrence of adverse reactions were beneficial to the early postoperative activities and shortening the hospitalization time of the patients.
【作者单位】：南方医科大学附属广州军区广州总医院麻醉科;
【基金】：广东省科技计划项目(2012B031800417)
【分类号】：R614.2

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