肋间神经阻滞在胸腔镜自发性气胸术后镇痛应用

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1、北京医学2015年第37卷第6期·561··论著·肋间神经阻滞在胸腔镜自发性气胸术后镇痛的应用李萌黄朝宇郭涛武宽韩哲【摘要】目的探讨肋间神经阻滞在电视辅助胸腔镜（VATS）自发性气胸术后镇痛的应用价值。方法120例自发性气胸患者均接受择期患侧单操作孔VATS探查和肺大疱切除术，随机分为3组：A组为单纯肋间神经阻滞组，采用0.375%罗哌卡因5ml在切口所在肋间及其上下各1个肋间的椎旁阻滞肋间神经；B组为肋间神经阻滞+经静脉患者自控镇痛（patientcontrolledintravenousanalgesia,PCIA）组，方案为氟比洛芬酯注射液200m

2、g+芬太尼20μg/kg+盐酸昂丹司琼注射液16mg；C组为单纯PCIA，方案同B组。观察并记录3组患者术后2、6、24、48h（T1~T4）在静息状态和活动状态下的视觉模拟评分（VAS评分）；记录B组和C组术后各时段静脉镇痛泵用量，及额外要求注射盐酸哌替啶的患者例数及用量。结果除A组T3时点静息状态外，A组和B组患者在术后T1~T3时点静息及活动状态的VAS评分明显低于C组（P＜0.05），尤以T1和T2时点为明显；T4时点B组和C组的VAS评分低于A组（P＜0.05），但B、C组间的差异无统计学意义。结论肋间神经阻滞+PCIA是胸腔镜自发性气胸手术后

3、比较满意的镇痛方案，肋间神经阻滞对胸腔镜自发性气胸手术后24h内的急性疼痛的镇痛效果明显优于单纯PCIA。【关键词】肋间神经阻滞自发性气胸电视胸腔镜视觉模拟评分法静脉自控镇痛ApplicationofintercostalnerveblockforpostoperativeanalgesiaafterbullactomyviaVTASfortreatingspontaneouspneumothoraxLiMeng,HuangZhaoyu,GuoTao,WuKuan,HanZhe.AnesthesiaDepartment,BeijingHaidianHos

4、pital,Beijing100080,ChinaCorrespondingauthor：GuoTao，Email：guotaoyuer@sohu.com【Abstract】ObjectiveTostudytheeffectofintercostalnerveblockforpostoperativeanalgesiaafterbullactomyviaVTASfortreatingspontaneouspneumothorax.MethodsOnehundredandtwentypatientswithspontaneouspneumo-thoraxw

5、hounderwentselectiveoperationsnamed“exploratorysurgeryandbullactomyviaVATSbysingleoperationchannel”andwererandomlydividedinto3groups:groupA:treatedonlybyintercastalnerveblock（5mlof0.375%ropi-vacainewasinjectedintotherootsofintercoastalneverswhichlocatedatthesideofthoracicvertebra

6、eandsupplythecutanditssurroundingsaswell）;groupB:treatedbyintercastalnerveblockcombinedwithPCIA（Thedrugconsistedofflur-biprofen200mgmixedwithfentanyl20μg/kgandondansetron16mg）;groupC:treatedonlybyPCIA.Allthepatientsofthe3groupswerefollowedupandevaluatedatthetimeof2,6,24and48hafte

7、rtheoperationwhenevertheywereatrestorduringexertion.TheevaluationcriteriawasaccordingtoVAS.Thenumberofthepatientswhohadbeeninjecteddolan-tinforrelievingpainwasrecorded.Besides,thedosagesofPCIAfromgroupBandgroupCwerecompletelyrecordedaswell.ResultsTheVASofgroupAandgroupBwassignifi

8、cantlylowerthanthatofgroupCinthefirst24h