摘要
目的观察超声引导下连续胸椎旁神经阻滞对开胸术后肺功能的影响。方法选择择期开胸手术患者60例,男29例,女31例,年龄18-60岁,BMI 16-28kg/m2,ASAⅠ或Ⅱ级,随机分为两组,每组30例。G组：单纯全身麻醉＋术后自控静脉镇痛（PCIA）;GP组：全麻复合连续胸椎旁神经阻滞（CTPVB）＋术后CTPVB镇痛,诱导前患者清醒时行CTPVB,通过测定阻滞范围判断CTPVB效果。两组均于术毕缝皮时启动镇痛泵行自控镇痛。记录患者拔出气管导管30min（T1）、术后2h（T2）、6h（T3）、24h（T4）、48h（T5）静息和咳嗽时VAS评分。采用肺功能仪测定入室后（T0）、T4、T5时的用力肺活量（FVC）、1秒用力呼气容量（FEV1）、最大呼气中段流量（MMF）,记录三次测量的最大值;用血气分析仪测定相应时段的血气分析各一次,抽取桡动脉血标本前停止吸氧30min,记录PaCO2、PaO2、肺泡动脉血氧分压差（PA-aO2）。观察术后不良反应发生情况。结果 T1-T5时GP组静息和咳嗽时VAS评分明显低于G组（P〈0.05）。与T0时比较,T4、T5时两组FVC、FEV1、MMF明显降低（P〈0.05）,GP组明显高于G组（P〈0.05）。与T0时比较,T4、T5时两组PaO2明显降低（P〈0.05）、PA-aO2明显增大（P〈0.05）;T4、T5时GP组的PaO2明显高于G组、PA-a O2明显小于G组（P〈0.05）。结论超声引导下CTPVB镇痛效果完善,可明显改善开胸术后肺功能,促进肺部氧合。
Objective To investigate the effect of continuous thoracic paravertebral block analgesia guided by sonography on pulmonary function after thoracotomy.Methods Sixty patients,male29 cases,female 31 cases,aged 18-60 years,BMI 16-28kg/m2,ASA gradeⅠ orⅡ,who had underwent thoracotomy were divided randomly into 2groups,30 cases each：group G with general anesthesia and postoperative patient controlled intravenous analgesia（PCIA）,whereas group GP with general anesthesia combined with continuous thoracic paravertebral block（CTPVB）and postoperative continuous CTPVB.CTPVB were performed before induction as the patient was conscious so that the effect of CTPVB could be tested by blocking range.Both resting and coughing visual analogue scales（VAS）were recorded at the points of 30 minutes after extubation（T1）,2hours after operation（T2）,6hours after operation（T3）,24 hours after operation（T4）and 48 hours after operation（T5）.Forced vital capacity（FVC）,forced expiratory volume in the first second（FEV1）and maximal mid expiratory flow（MMF）were measured by spirometer and the three maximal values were recorded at time points of entry of operating room（T0）,T4 and T5.Blood gas analysis was employed at corresponding time points by a blood gas analyzer and oxygen inhalation was ceased 30 minutes before drawing blood from radial artery.PaCO2,PaO2 and alveolararterial oxygen difference（PA-aO2）were recorded.Adverse effects were observed.Results Compared with group G,VAS when resting and coughing in group GP at T1-T5 decreased significantly（P〈0.05）.Compared with T0,FVC,FEV1,MMF and PaO2 at T4,T5 in both groups decreased significantly（P〈0.05）,PA-aO2 increased significantly（P〈0.05）.Compared with group G,PaO2 in group GP at T4,T5 increased and PA-aO2 in group GP at T4,T5 decreased significantly（P〈0.05）.Conclusion CTPVB guided by sonography had excellent effect.It can not only improve pulmonary function after thoracotomy significantly but also promote intrapulmonary oxygenation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2016年第2期118-121,共4页
Journal of Clinical Anesthesiology
关键词
超声引导
胸椎旁神经阻滞
肺功能
开胸手术
镇痛
Ultrasound guided
Thoracic paravertebral block
Pulmonary function
Thoracotomy
Analgesia
作者简介
通信作者：杨纲华，Email：yangganghua745@sina．com
