曾彩红 刘湘杰 吴许芳 关栢锐 阳兴

【摘要】 目的：研究超聲引导下胸椎旁神经阻滞应用于下肺叶切除术患者的镇痛效果。方法：选取2020年1-10月本院收治的肺叶切除患者62例为研究对象，按随机数字表法将其分为对照组和试验组，各31例。对照组予以单纯的全身麻醉，试验组在全身麻醉前行超声引导下胸椎旁神经阻滞。观察两组患者术后6、12 h静息及活动时疼痛评分，48 h内PCA泵总用量及按压次数，肾上腺素水平及苏醒情况。结果：试验组术后6、12 h静息及活动时疼痛评分均低于对照组，差异均有统计学意义（P<0.05）。试验组48 h内PCA泵总用量及按压次数均低于对照组，差异均有统计学意义（P<0.05）。试验组术后24 h的肾上腺素水平低于对照组，差异有统计学意义（P<0.05）。两组苏醒时间、拔管时间、自主呼吸恢复时间比较，差异均无统计学意义（P>0.05）。结论：超声引导下胸椎旁神经阻滞应用于下肺叶切除术患者可以减轻术后疼痛的程度及次数，减少应激反应，不会影响患者苏醒。

【关键词】 超声引导下胸椎旁神经阻滞 应激指标 VAS评分 全身麻醉

Analysis of Analgesic Effect of Ultrasound-guided Parathoracic Nerve Block in Patients with Lower Pulmonary Lobectomy/ZENG Caihong， LIU Xiangjie， WU Xufang， GUAN Bairui， YANG Xing. //Medical Innovation of China， 2021， 18（05）： 0-055

[Abstract] Objective： To study the analgesic effect of ultrasound-guided parathoracic paravertebral nerve block in patients with lower pulmonary lobectomy. Method： A total of 62 patients with lobotomy admitted to our hospital from January to October 2020 were selected as the research objects， they were divided into control group and experimental group according to random number table method， 31 cases in each group. The control group received pure general anesthesia， the experimental group received ultrasound-guided parathoracic nerve block before general anesthesia. Pain scores at rest and activity 6 and 12 h after surgery， total amount of PCA pump and times of pressing within 48 h， epinephrine level and recovery were compared between the two groups. Result： The pain scores at rest and activity in the experimental group were lower than those in the control group 6 and 12 h after surgery， the differences were statistical significance （P<0.05）. The total dosage and pressing times of PCA pump in experimental group were lower than those in control group within 48 h， the difference were statistical significance （P<0.05）. The epinephrine level 24 h after operation in the experimental group was lower than that in the control group， the difference was statistically significant （P<0.05）. There were no significant differences in recovery time， extubation time and recovery time of spontaneous respiration between the two groups （P>0.05）. Conclusion： Ultrasound-guided parathoracic paravertebral nerve block can be used in patients with lower pulmonary lobectomy to reduce the degree and frequency of postoperative pain， reduce the stress response， not affect the patients recovery.

[Key words] Ultrasound-guided parathoracic nerve block Stress indicators Visual analogue scale score General anesthesia

First-authors address： Jiangmen Central Hospital， Jiangmen 529050， China

doi：10.3969/j.issn.1674-4985.2021.05.014

下肺叶切除术是一项创伤较大的手术，术后疼痛明显，应激反应较激烈[1]。而手术前麻醉的质量对于术后疼痛及应激反应有较大的影响[2]。在临床上，常用的麻醉方式是单纯全麻，但是此种麻醉方式术后疼痛控制并不完全理想，仍会引起患者机体产生应激反应。为了提高麻醉质量，考虑局部麻醉支配肺下叶的神经可能会有好的作用，但是进行胸椎旁的神经解剖位置的特殊性，麻醉操作的难度很大。超声通过物理方法可以看清楚局部的解剖结构，可以在超声的引导下将麻醉药物直接注入胸椎的脊神经根，达到了局部阻滞神经信号的传导，可以达到局部阻滞神经的作用。……