超声引导单次胸椎旁阻滞应用于全麻下老年胸腔镜手术的临床疗效

发布时间：2018-09-01 14:18

【摘要】：目的探讨超声引导下经胸单次胸神经阻滞治疗老年胸外科全麻患者的临床疗效。方法择期行胸腔镜手术患者80例,年龄60~80岁,按照随机数字表分为静吸复合全身麻醉组(对照组)和全身麻醉复合行单次胸椎旁神经阻滞组(观察组),每组各40例。对照组采用常规顺序静脉诱导,并插入左侧双腔支气管内导管。观察组患者麻醉诱导与对照组相同,气管内插管成功后在超声引导下于手术侧T4~T5行胸椎旁神经阻滞。两组患者术前麻醉维持均采用静吸复合麻醉,并维持脑电双频指数(BIS)值40~60,记录术中瑞芬太尼用量、术后各时间点(2、6、12、24、48h)安静及活动时视觉模拟疼痛评分(VAS)及相关并发症。结果相比对照组,观察组患者术中瑞芬太尼剂量更少(P0.05);观察组患者术后2,6,12 h安静及活动时疼痛评分更低(P0.05);观察组患者术后躁动、恶心、呕吐等发生率明显降低(P0.05)。结论全身麻醉联合单次胸椎旁阻滞镇痛效果明显,减少术中阿片类镇痛药的用量;同时也降低了术后早期(6 h内)VAS评分以及术后躁动及恶心、呕吐等不良并发症的发生率。
[Abstract]:Objective To investigate the clinical effect of ultrasound-guided single thoracic nerve block in elderly patients undergoing thoracic surgery under general anesthesia.Methods Eighty patients aged 60-80 years who underwent thoracoscopic surgery were randomly divided into two groups:the control group and the observation group. Patients in the observation group were anesthetized in the same way as those in the control group. Parathoracic nerve block was performed under the guidance of ultrasound at the operative side of T4-T5 after successful endotracheal intubation. Remifentanil dosage during operation, visual analogue pain score (VAS) and related complications were recorded at all time points (2,6,12,24,48 hours) after operation. Results Compared with the control group, the observation group had less intraoperative remifentanil dosage (P 0.05), and the observation group had lower pain score at 2,6,12 hours after operation (P 0.05). Conclusion General anesthesia combined with single thoracic paravertebral block has obvious analgesic effect and can reduce the dosage of opioid analgesics during operation. It also reduces the early postoperative VAS score and the incidence of postoperative adverse complications such as agitation, nausea and vomiting.
【作者单位】：浙江大学湖州医院麻醉科;
【分类号】：R614.2

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