超声引导下椎旁神经阻滞在老年人开胸手术术后镇痛中的疗效

发布时间：2018-04-14 22:50

本文选题：超声引导 + 椎旁神经阻滞　；参考：《中国老年学杂志》2015年07期

【摘要】：目的探讨老年患者开胸手术采用椎旁神经阻滞术后镇痛的有效性、安全性及康复意义。方法选用该院60岁以上老年开胸手术患者60例,随机分成实验组和对照组,实验组患者麻醉前行椎旁神经阻滞,术毕给予地佐辛辅舒芬太尼静脉PCIA,对照组术毕给予地佐辛辅舒芬太尼静脉自控镇痛(PCIA)。记录两组患者Prince-Henry术后疼痛评分,PICA按压次数、患者满意度并观察和统计不良反应的发生情况。结果两组患者性别、年龄、身高、体重及手术时间等一般情况差异无统计学意义(P0.05)。实验组患者术后2、6、12、24 h各时间点Prince-Henry评分明显低于对照组。实验组未发生因超声引导椎旁神经阻滞引起的并发症,48 h时间点Prince-Henry评分差别不具备统计学意义。实验组术后需要额外追加芬太尼的例数及术后镇痛泵按压次数明显少于对照组,且患者满意率明显高于对照组(均P0.05)。实验组术后镇痛期间不良反应发生率明显高于对照组(P0.05)。结论椎旁神经阻滞辅以持续静脉输注镇痛效果显著,明显减少静脉麻醉镇痛药使用量,降低术后恶心、呕吐、嗜睡、皮肤瘙痒、呼吸抑制等并发症,可安全有效地用于老年人开胸手术术后镇痛。
[Abstract]:Objective to evaluate the efficacy, safety and rehabilitation of paraspinal nerve block in elderly patients undergoing thoracotomy.Methods Sixty patients over 60 years old undergoing thoracotomy were randomly divided into experimental group and control group. The experimental group had paraspinal nerve block before anesthesia.The patients in the control group were treated with Dizocincin sufentanil intravenous analgesia after operation and PCIA with dextroxine sufentanil at the end of operation.The pain score, the number of times of compression, the satisfaction of patients and the occurrence of adverse reactions were recorded in the two groups after Prince-Henry.Results there was no significant difference in sex, age, height, weight and operation time between the two groups.The Prince-Henry score of the experimental group was significantly lower than that of the control group.There was no significant difference in Prince-Henry score at 48 h after the complications caused by ultrasonic guided paraspinal nerve block in the experimental group.The number of patients who needed additional fentanyl and the times of postoperative analgesic pump pressing were significantly lower in the experimental group than in the control group, and the satisfaction rate of the patients was significantly higher than that in the control group (all P 0.05).The incidence of adverse reactions during postoperative analgesia in the experimental group was significantly higher than that in the control group (P 0.05).Conclusion Paraspinal nerve block combined with continuous intravenous infusion can significantly reduce the use of intravenous analgesics, reduce postoperative nausea, vomiting, lethargy, pruritus, respiratory inhibition and other complications.It can be safely and effectively used for postoperative analgesia in elderly patients undergoing thoracotomy.
【作者单位】：吉林大学第二医院麻醉科;吉林大学第二医院手术室;
【分类号】：R614.4

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