王芳

【摘要】 目的：探究老年开胸手术患者术后镇痛中超声引导下椎旁神经阻滞的应用对患者VAS评分的影响。方法：选取2018年1月-2020年4月本院收治的60例老年开胸手术患者，按照随机数字表法分为对照组和研究组，每组30例。对照组进行常规的药物镇痛，研究组则在常规药物镇痛的基础上进行超声引导下椎旁神经阻滞治疗。观察对比患者的VAS评分、自控静脉镇痛的用药量、不良反应的發生情况、追加芬太尼数量、术后镇痛泵按压次数以及患者满意度。结果：研究组在术后2、6、12、24 h的VAS评分均低于对照组，差异均有统计学意义（P<0.05）。研究组在术中、术后48 h镇痛药物用量均低于对照组，差异均有统计学意义（P<0.05）。研究组的不良反应发生率低于对照组，差异有统计学意义（P<0.05）。研究组的追加芬太尼数量、术后镇痛泵按压次数低于对照组，满意度高于对照组，差异均有统计学意义（P<0.05）。结论：在老年开胸手术患者术后镇痛中应用超声引导下椎旁神经阻滞方式，能够明显缓解患者因手术创伤所产生的疼痛，降低临床上的VAS评分，同时持续降低术中、术后镇痛药物的用药量，尽可能减少对老年患者机体的损害，且降低患者因麻醉产生的不良反应发生率，具有较好的安全性，进一步减少芬太尼用药剂量及术后镇痛泵按压次数，提高患者的满意度，值得推广应用。

【关键词】 老年开胸手术 术后镇痛 超声引导下椎旁神经阻滞 VAS评分

Effect of Ultrasound-guided Paravertebral Nerve Block on VAS Score in Elderly Patients Undergoing Thoracotomy/WANG Fang. //Medical Innovation of China， 2021， 18（07）： 0-052

[Abstract] Objective： To explore the effect of ultrasound-guided paravertebral nerve block on VAS score in elderly patients undergoing thoracotomy. Method： A total of elderly patients with thoracotomy admitted to our hospital from January 2018 to April 2020 were selected， they were divided into control group and research group according to random number table method， 30 cases in each group. The control group received conventional drug analgesia， while the study group received ultrasound-guided paravertebral nerve block treatment on the basis of conventional drug analgesia. The VAS score， dosage of patient controlled intravenous analgesia， the occurrence of adverse reactions， the number of Fentanyl addition， the number of postoperative analgesia pump pressing and patient satisfaction were observed and compared. Result： The VAS scores of the study group at 2， 6， 12 and 24 h after surgery were lower than those of the control group， the differences were statistical significance （P<0.05）. The amount of analgesic drugs in the study group was lower than that in the control group during and 48 h after surgery， the differences were statistical significance （P<0.05）. The incidence of adverse reactions in the study group was lower than that in the control group， the difference was statistically significant （P<0.05）. The amount of additional Fentanyl and the number of postoperative analgesia pump pressing in the study group were lower than those in the control group， the degree of satisfaction in the study group was higher than that in the control group， the differences were statistical significance （P<0.05）. Conclusion： The application of ultrasound-guided paravertebral nerve block in postoperative analgesia for the elderly patients undergoing thoracotomy can significantly alleviate the pain caused by surgical trauma and reduce the clinical VAS score; at the same time， it can continuously reduce the dosage of patient controlled intravenous analgesia during and after operation， reduce the damage to the elderly patients as much as possible， and reduce the incidence of adverse reactions caused by anesthesia. It has better safety， further reduce the dosage of Fentanyl and the number of postoperative analgesia pump pressing， and improve the patients satisfaction. It is worth of popularizing.

[Key words] Elderly thoracotomy Postoperative analgesia Ultrasound-guided paravertebral nerve block

VAS score

First-authors address： The Central Hospital of Jiamusi City， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.07.012

由于老年人機体的特殊性，其具有比较明显的生理变化，同时其具有个体差异大、较低的脏器储备、代偿功能等多种有关因素，因此增加了老年人术后镇痛的难度[1]。开胸手术具有创伤大的特征，如未及时且有效对其进行处理，极易使得老年患者产生身体不适等不良症状，对其生活质量产生较大的影响，严重时极易形成肺炎和气道梗阻等多种比较严重的并发症[2]。传统临床上普遍利用药物进行镇痛，效果并不理想。现阶段普遍利用椎旁神经阻滞方式进行术后镇痛，其只对手术侧躯体的椎旁神经发挥作用，尽可能降低对老年人生理的影响，具有理想效果[3]。本文研究分析了老年开胸手术患者术后镇痛中超声引导下椎旁神经阻滞的应用对患者VAS评分的影响，现报道如下。……