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Received:October 21, 2020 Published Online:June 20, 2021
Received:October 21, 2020 Published Online:June 20, 2021
中文摘要: 目的 通过比较超声引导下胸椎旁神经阻滞(TPVB)和竖脊肌平面阻滞 (ESPB)用于胸腔镜手术的临床疗效,探索胸科手术围术期安全有效的镇痛方法。方法 选择山西白求恩医院2019年6月至2019年12月择期全身麻醉下行胸腔镜下肺叶切除术患者50例,随机分成T、E两组,每组25例。在全身麻醉诱导前，T组使用0.5%罗哌卡因20 ml 行TPVB,E组使用0.5%罗哌卡因20 ml行ESPB。诱导后均采取丙泊酚和舒芬太尼行全凭静脉麻醉维持,术毕使用舒芬太尼行静脉患者自控镇痛(PCA)。记录两组患者术中舒芬太尼用量、手术时间、苏醒时间(停药到呼之睁眼的时间)、拔管时间(停药到拔管的时间);记录两组患者术后 1、6、8、12、24 h 静息及咳嗽时VAS评分，术后镇痛泵首次按压时间、术后48 h内镇痛泵有效按压次数以及氟比洛芬酯补救率、不良反应的发生情况。结果 T组和E组术中舒芬太尼的用量、手术时间、苏醒时间、拔管时间差异无统计学意义(P>0.05)。两组患者术后1、6、8 h静息及咳嗽时的VAS评分差异无统计学意义(P>0.05),术后12、24 h E组静息及咳嗽时的VAS评分均高于T组(P<0.05)。E组术后镇痛泵首次按压时间明显早于T组(P<0.05),术后48 h内镇痛泵有效按压次数及氟比洛芬酯镇痛补救率均明显高于T组(P<0.05)。两组患者术后均未出现呼吸抑制、躁动,E组恶心呕吐的发生率明显高于T组(P<0.01，P<0.05)。结论 超声引导下TPVB的镇痛效果优于ESPB,镇痛持续时间长,操作简单安全,不良反应少。
Abstract:bral nerve block (TPVB) and erector spinae plane block (ESPB) for thoracoscopic lobectomy and explore safe and effective analgesia during the perioperative period of thoracic surgery. Methods A total of 50 patients undergoing thoracoscopic lobectomy under selective general anesthesia in Shanxi Bethune Hospital from June 2019 to December 2019 were randomly divided into group T and group E (n=25,each).Before the induction of general anesthesia,TPVB was performed with 0.5% ropivacaine in group T,and ESPB was performed with 0.5% ropivacaine in group E. In both groups,propofol and sufentanil were used for maintenance of total intravenous anesthesia after induction,and sufentanil was used for intravenous patient-controlled analgesia (PCA) at the end of the operation.The dosage of sufentanil during operation,operation time,wake-up time (duration from drug withdrawal to eye opening),extubation time (duration from drug withdrawal to extubation)were compared between two groups.Visual analog score(VAS)at rest and during coughing at 1-,6-,8-,12- and 24-hour after operation,the first pressing time of PCA pump,the effective pressing times of PCA pump within 48 hours after operation,the resue rate of flurbiprofen axetil and the occurrence of adverse reactions were observed and compared between two groups. Results There was no significant difference in the dosage of sufentanil,operation time,wake-up time,extubation time and VAS scores at rest and during coughing at 1-,6-,8-h after operation between two groups (P>0.05).At 12- and 24-h after surgery,VAS scores in group E were significantly higher than those in group T (P<0.05).Compared with group T,the first pressing time of PCA pump was significantly earlier,and the effective pressing times of analgesia pump and the rescue rate of flurbiprofen axetil within 48 hours after operation were significantly higher in group E (all P<0.05).The incidence of nausea and vomiting in group E was significantly higher than that in group T (P<0.05).No respiratory depression or restlessness occurred after operation in both groups. Conclusion The analgesic effect of ultrasound-guided TPVB is superior to that of ESPB,and TPVB is characterized by long duration of analgesia,simple and safe operation and mild adverse reactions.
keywords: Thoracic paravertebral nerve block Erector spinal plane block Thoracoscopy Postoperative analgesia Ropivacaine Visual analogue score Patient-controlled analgesia
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