上海交通大学学报(医学版)

• 论著(临床研究) • 上一篇    下一篇

超声引导联合神经刺激仪定位胸椎旁阻滞在肋间神经移位术中的应用

崔娓 1, 2,张弛 2,葛培青 2,王雪湖 2,叶照君 2,于士剑 2,张依爵 2,陶伟平 2,袁红斌 1   

  1. 1. 第二军医大学附属长征医院麻醉科,上海 200433;2. 上海市静安区中心医院麻醉科,上海 200040
  • 出版日期:2017-01-28 发布日期:2017-01-19
  • 通讯作者: 陶伟平,电子信箱:13331901392@189.cn;袁红斌,电子信箱:jfjczyy@163.com。
  • 作者简介:崔娓(1981—),女,主治医师,学士;电子信箱:cuiweiyt@163.com。

Application of ultrasound guided and nerve stimulator located thoracic paravertebral nerve block to #br# intercostal nerve transfer surgery

CUI Wei1, 2, ZHANG Chi2, GE Pei-qing2, WANG Xue-hu2, YE Zhao-jun2, YU Shi-jian2, ZHANG Yi-jue2, TAO Wei-ping2, YUAN Hong-bin1   

  1. 1. Department of Anesthesiology, Changzheng Hospital, the Second Military Medical University, Shanghai 200433, China; 2. Department of Anesthesiology, Central Hospital of Jing’an District , Shanghai 200040, China
  • Online:2017-01-28 Published:2017-01-19

摘要:

目的 ·观察超声引导联合神经刺激仪定位胸椎旁阻滞(TPVB)用于肋间神经移位术患者的术后镇痛效果、并发症及对血流动力学的影响。方法 ·选择肋间神经移位患者60例,随机分为椎旁阻滞镇痛组(T组)和静脉镇痛组(V组),各30例。T组患者麻醉前在超声引导联合神经刺激仪定位下行T4~T5单次椎旁神经阻滞,注入0.375%的罗哌卡因+地塞米松5 mg 混合液共20 mL,记录阻滞平面及并发症,观察注药后血压、心率的变化;V组患者在术后通过静脉按需给予镇痛药物。2组患者均记录术后6 h和12 h的视觉模拟评分(VAS),进行组间比较。结果 · TPVB 范围为术侧T3~T7,即5个节段的感觉阻滞;无其他并发症;对血压、心率无明显影响。T组术后6 h的VAS 评分显著少于V组(P=0.001);术后12 h的VAS在组间比较,差异无统计学意义。结论 ·超声引导联合神经刺激仪定位下的TPVB 操作简单、安全,阻滞平面广,并发症少,镇痛完善,对于疼痛较严重的肋间神经移位术患者,是术后镇痛有效方法。

关键词: 胸椎旁阻滞, 超声, 神经刺激仪, 术后镇痛, 肋间神经移位术

Abstract:

Objective · To observe the effects of ultrasound guided and nerve stimulator located thoracic paravertebral nerve block (TPVB) for patients undergoing intercostal nerve transfer surgery on postoperative pain relief, complications, and hemodynamics. Methods · Sixty patients undergoing intercostal nerve transfer surgery were recruited and randomly assigned to receiving TPVB analgesia (Group T) and intravenous analgesia (Group V) with 30 patients in each group. Group T received thoracic paravertebral block guided by ultrasound and located by nerve stimulator. 20 mL of 0.375% ropivacaine with 5 mg of dexamethasone were injected into the thoracic paravertebral space of T4-T5. Changes in arterial pressure and heart rate were observed, and the range of intercostal nerve block and complications were recorded. Group V received intravenous analgesia after operation on demand. Visual analogue scale (VAS) scores 6 h and 12 h after surgery were recorded and compared between groups. Results · Five dermatome segments of intercostal nerve between T3 and T7 at surgical side were blocked. No complications and significant changes in arterial pressure and heart rate were observed. The VAS scores 6 h after surgery were significantly lower in Group T than in Group V (P=0.001). The differences in VAS scores 12 h after surgery between two groups were not statistically significant. Conclusion · Ultrasound guided and nerve stimulator located TPVB is easy and safe to perform and provides wide range of intercostal nerve block with less complications and perfect analgesia. It is especially applicable to pain relief after the intercostal nerve transfer surgery for patients with severe pain.

Key words: thoracic paravertebral block, ultrasound, nerve stimulator, postoperative analgesia, intercostal nerve transfer