超声引导下平面内经外侧肋间入路行胸椎旁阻滞的临床评价

发布时间：2018-03-10 21:38

本文选题：胸外科手术　切入点：麻醉　出处：《北京大学学报(医学版)》2017年01期 　论文类型：期刊论文

【摘要】：目的:评估在超声引导下采用平面内方法,经外侧肋间入路行胸椎旁阻滞技术的可行性和成功率。方法:选取27例择期行胸外科手术的患者,于术前进行胸椎旁阻滞。超声探头置于脊柱旁8 cm左右,平行肋骨长轴在第5肋间隙进行扫描,以肋间内肌和肋间最内肌之间的间隙作为穿刺目标进针,穿刺针到达目标区域后,推注0.5%(质量分数)罗哌卡因20 m L后置管,在超声下评估导管头端位置是否良好,记录给药后10、20、30 min冷触觉阻滞平面。术后连接镇痛泵经导管持续泵注0.2%罗哌卡因6 m L/h进行镇痛,记录术后1、6、24、48 h冷触觉阻滞平面及疼痛程度评分。结果:1次置管成功率81.48%(22/27),另5例患者分别在第2次置管和第3次置管后成功。给予负荷剂量给药后10、20、30 min冷触觉阻滞平面数中位数分别为2、3、4,术后1、6、24、48 h冷触觉阻滞平面数及疼痛程度评分中位数分别为5、5、5、4以及1、1、2、2,无患者发生双侧阻滞、气胸及误穿血管等并发症。结论:采用上述外侧肋间入路技术进行胸椎旁阻滞具有良好的可行性,阻滞成功率高,并发症少。
[Abstract]:Objective: to evaluate the feasibility and success rate of thoracic paravertebral block via lateral intercostal approach under ultrasound guidance. Thoracic paravertebral block was performed before operation. The ultrasonic probe was placed about 8 cm beside the spine, parallel rib long axis was scanned in the fifth costal space, and the space between intercostal and intercostal innermost muscles was used as the puncture target. After the puncture needle reached the target area, 0.5% ropivacaine (mass fraction) was injected with 20 mL posterior tube to evaluate the good position of the catheter head under ultrasound. The cold tactile block level was recorded at 10: 20 and 30 min after administration. Postoperative analgesic pump was continuously injected with 0.2% ropivacaine for 6 mL / h. The scores of cold tactile block level and pain degree were recorded at 1: 6 and 24 / 48 hours postoperatively. Results the success rate of 1: 1 catheterization was 81.48 ~ 22 / 27, and the other 5 patients were successfully placed at the second and third times respectively. Cold tactile block was performed at 10 ~ 20 ~ 30 min after administration of loading dose. The median of plane number was 2 / 3 / 4, and the median of cold tactile block level and pain score were 5 / 5, 5 / 4 and 1 / 1 / 2 / 2, respectively. No bilateral block was found in the patients with cold tactile block at 1: 6 and 24 / 48 h postoperatively. The median score of cold tactile block and pain degree were 5, 5, 5 and 2, respectively. Conclusion: the technique of lateral intercostal approach is feasible for thoracic paravertebral block with high success rate and few complications.
【作者单位】：北京大学第三医院麻醉科;北京大学第三医院胸外科;
【分类号】：R614

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