饶瑾　宗志军　高之心　王义桥　李元海

摘 要：目的 觀察超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治术患者的镇痛效果。方法 选择择期开放性胃癌根治手术患者50例，随机数字表法随机分为全麻组（G组）和全麻复合椎旁神经阻滞组（P组），各25例。G组行气管插管静脉全麻，P组于全麻前行超声引导椎旁神经阻滞。记录基础值（T0）、手术前（T1）、手术5 min（T2）、手术探查时（T3）、手术20 min（T4）、手术1 h（T5）、手术结束（T6）各时间点的MAP和HR，患者术后2 h、4 h、8 h、12 h、24 h、48 h的静息和活动时的VAS评分，术中及术后镇痛药物用量，气管拔管时间，PACU停留时间，观察相关并发症的发生率。结果 与G组对比，P组术后4 h、8 h、12 h、24 h的静息及12 h内的活动时VAS评分降低，气管拔管时间缩短，术后躁动发生率降低，差异均具有统计学意义（P<0.05），术中舒芬太尼及术后追加镇痛药用量降低，T2、T3时间点的MAP及T2、T3、T4、T5时间点的HR较低，更为平稳。结论 超声引导双侧T7-9椎旁神经阻滞用于开放性胃癌根治手术患者具有良好的镇痛作用。

关键词：双侧椎旁神经阻滞；超声引导；镇痛；胃癌根治术

中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.025

文章编号：1006-1959（2018）11-0080-05

Observation on Analgesic Effect of Bilateral Thoracic Paravertebral Nerve Block Guided by Ultrasound in Patients Undergoing Open Radical Gastrectomy for Gastric Cancer

RAO Jin，ZONG Zhi-jun，GAO Zhi-xin，WANG Yi-qiao，LI Yuan-hai

（Department of Anesthesiology，First Affiliated Hospital of Anhui Medical University，Hefei 230022，Anhui，China）

Abstract：Objective To observe the effect of ultrasound guided bilateral T7-9paravertebral nerve block for analgesia in patients undergoing open radical gastrectomy for gastric cancer.Methods A total of 50 patients undergoing elective open radical gastrectomy for gastric cancer were randomly selected and randomized into general anesthesia group（G group）and general anesthesia paravertebral nerve block group（P group），25 cases each.In the G group，tracheal intubation was performed intravenously，and in the P group， ultrasound guided paravertebral nerve block was performed before general anesthesia.Record baseline（T0），preoperative（T1），5 min（T2）， surgical exploration（T3），MAP and HR at 20 min（T4），1 h（T5），and the end of the operation（T6）at each time point after surgery，and resting at 2 h，4 h，8 h，12 h，24 h，and 48 h after surgery VAS scores at and during exercise，intraoperative and postoperative analgesic drug usage，tracheal extubation time，and PACU retention time were used to observe the incidence of related complications.Results Compared with group G，VAS scores decreased at 4 h，8 h，12 h，24 h after operation，and VAS scores within 12 h after operation，and tracheal extubation time was shortened， and the incidence of postoperative agitation was decreased，the difference was statistically significant（P<0.05），intraoperative sufentanil and postoperative additional analgesics decreased，MAP at T2，T3，and HR at T2，T3，T4，and T5 were lower and more stable.Conclusion Ultrasound-guided bilateral T7-9paravertebral nerve block has a good analgesic effect in open radical gastrectomy for gastric cancer patients.

Key words：Bilateral thoracic paravertebral nerve block；Ultrasound guidance；Analgesia；Radical gastrectomy for gastric cancer

胃癌（gastric cancer）是我国最常见的肿瘤之一，胃癌根治术是其有效的治疗手段，然而开放性胃癌根治术剧烈地术后疼痛，常常限制患者术后早期活动，甚至導致患者慢性疼痛，极不利于患者康复，给患者术后生活质量带来极大地影响[1]。硬膜外麻醉作为开腹胃癌根治术术后镇痛的金标准，主要是通过将局麻药物注入硬膜外腔进而阻滞神经根起到镇痛作用，且在一定程度上减轻呼吸抑制及下肢血栓形成的风险，然而由于其具有尿潴留、低血压，及其相关禁忌症的局限性，限制其临床运用。研究显示椎旁神经阻滞可产生神经轴索阻滞及腹壁间阻滞的有效麻醉作用，并伴有交感神经阻滞，效果等同于单侧硬膜外麻醉效果，且并发症更少[2-4]。……