超声引导下颈部迷走神经阻滞联合胸椎旁阻滞在胸腔镜手术中的应用

doi:10.3969/j.issn.1674-8115.2021.01.011

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (1): 66-69.doi: 10.3969/j.issn.1674-8115.2021.01.011

超声引导下颈部迷走神经阻滞联合胸椎旁阻滞在胸腔镜手术中的应用

程晨(), 范坤, 张瑛()

上海交通大学附属第六人民医院麻醉科，上海 200233

出版日期:2021-01-28 发布日期:2021-02-22
通讯作者: 张瑛 E-mail:chchen249@163.com;zhang198069ying@163.com
作者简介:程晨（1990—），男，护师，学士；电子信箱：chchen249@163.com。
基金资助:
上海市第六人民医院东院院级课题(DY2019022)

Application of ultrasound-guided cervical vagal block combined with thoracic paravertebral block in thoracoscopy

Chen CHENG(), Kun FAN, Ying ZHANG()

Department of Anaesthesiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China

Online:2021-01-28 Published:2021-02-22
Contact: Ying ZHANG E-mail:chchen249@163.com;zhang198069ying@163.com
Supported by:
Funding Information] Project of Shanghai Sixth People's Hospital East(DY2019022)

摘要/Abstract

摘要：

目的·评估超声引导下颈部迷走神经阻滞（cervical vagal block，CVB）联合胸椎旁阻滞（thoracic paravertebral block，TPVB）在胸腔镜肺大疱切除术中的安全性和有效性。方法·纳入2019年1月—2020年2月于上海交通大学附属第六人民医院东院择期行胸腔镜下肺大疱切除术患者40例，采用随机数字表将其分为双腔支气管插管全身麻醉（general anaesthesia with double lumen tube，GA+DLT）组20例，以及非气管插管神经阻滞麻醉（non-intubated nerve block anaesthesia，NINBA）组20例。GA+DLT组采用支气管插管静吸复合全身麻醉，术后采用患者静脉自控镇痛（patient controlled intravenous analgesia，PCIA）。NINBA组行超声引导下CVB联合TPVB，予0.5%罗哌卡因40 mL。记录2组患者术中是否出现呛咳、出血量、低氧血症发生情况和手术时间，术后胸闷发生情况、运动视觉模拟评分（visual analogue score，VAS）、恶心呕吐发生率、术后帕瑞昔布钠使用次数、术后住院天数及Bruggermann舒适评分（Bruggermann Comfort Score，BCS）。用 SPSS 19.0 软件进行统计学分析，定量资料以 $x ˉ ± s$ 表示，组间比较采用t检验；定性资料采用χ²^{检验。结果·2组患者术中均未出现低氧血症和呛咳，出血量和手术时间差异无统计学意义。NINBA组患者术后运动VAS较GA+DLT组低（P=0.008），术后帕瑞昔布钠使用次数较GA+DLT组少（P=0.000）；NINBA组患者BCS较GA+DLT组明显升高（P=0.020）；与NINBA组比较，GA+DLT组患者术后恶心呕吐发生率高。结论·超声引导下CVB联合TPVB可安全、有效地用于胸腔镜下肺大疱切除术。}

关键词: 迷走神经阻滞, 胸椎旁阻滞, 超声引导, 胸腔镜, 肺大疱切除术

Abstract:

Objective·To evaluate the safety and effectiveness of ultrasound-guided cervical vagal block combined with thoracic paravertebral block in resection of pulmonary bullae by thoracoscopy.

Methods·Forty patients, scheduled for the resection of pulmonary bullae by thoracoscopy in the East Branch of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University from Jan. 2019 to Feb. 2020, were randomly divided into two groups (n=20 each): general anaesthesia with double lumen tube (GA+DLT) group and non-intubated nerve block anaesthesia (NINBA) group. The GA+DLT group was treated with combined general anaesthesia and patient controlled intravenous analgesia (PCIA). In the NINBA group, cervical vagal block and thoracic paravertebral block were performed under the guidance of ultrasound, and 40 mL of 0.5% ropivacaine was given. Intraoperative cough, intraoperative hemorrhage, intraoperative hypoxemia, operation time, postoperative chest distress, visual analogue score (VAS) of sport, incidence of nausea and vomiting, time of parecoxib sodium use, postoperative hospital stay and Bruggermann Comfort Score (BCS) were recorded. SPSS 19.0 software package was used for statistical analysis. The data were expressed as x±s with t test for group comparison, and χ² test was used for qualitative data.

Results·There was no hypoxemia and cough in the two groups, and there was no significant difference in blood loss and operation time. The VAS of sport of the NINBA group was lower than that of the GA+DLT group (P=0.008); the time of using parecoxib sodium of the NINBA group was less than that of the GA+DLT group (P=0.000); the BCS of the patients in the NINBA group was significantly higher than that of the GA+DLT group (P=0.020). Compared with the NINBA group, the incidence of postoperative nausea and vomiting was higher in the GA+DLT group.

Conclusion·Ultrasound-guided cervical vagal block combined with thoracic paravertebral block can be safely and effectively used in the resection of pulmonary bullae by thoracoscopy.

Key words: vagal block, thoracic paravertebral block, ultrasound-guided, thoracoscopy, resection of pulmonary bullae

中图分类号:

R614.2

程晨, 范坤, 张瑛. 超声引导下颈部迷走神经阻滞联合胸椎旁阻滞在胸腔镜手术中的应用[J]. 上海交通大学学报(医学版), 2021, 41(1): 66-69.

Chen CHENG, Kun FAN, Ying ZHANG. Application of ultrasound-guided cervical vagal block combined with thoracic paravertebral block in thoracoscopy[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(1): 66-69.

图/表 4

图1 超声引导下迷走神经阻滞Note:A. Vagus nerve anatomical image. B. Needle image. VN—vagus nerve; SM—sternocleidomastoid; IJV—internal jugular vein; CCA—common carotid artery; LA—local anesthetics; arrow—needle direction.

Fig 1 Ultrasound-guided vagal block

图2 超声引导下胸椎旁阻滞Note:A. Paravertebral nerve anatomical image. B. Needle image. SP—spinous process; ZP—zygapophyseal; TPV—thoracic paravertebral space; P—pleura; arrow—needle direction.

Fig 2 Ultrasound-guided thoracic paravertebral block

表1 患者一般资料比较

Tab 1 Comparison of general data of patients

Indicator	Group
Indicator	NINBA （n=20）	GA+DLT （n=20）
Age/year	29.5±2.7	34.4±2.8
Male/female/n	19/1	19/1
BMI/(kg·m^-2)	22.7±3.5	21.4±5.8
Blood loss/mL	23.5±4.6	18.9±6.5
Hypoxemia of intraoperation/n (%)	0 （0）	0 （0）
Cough/n (%)	0 （0）	0 （0）
Operation time/h	42.0±5.8	40.0±9.5

表2 2组患者术后观察指标比较

Tab 2 Comparison of postoperative observation indexes between the two groups

Indicator	Group
Indicator	NINBA （n=20）	GA+DLT （n=20）
Hypoxemia of postoperation/n (%)	0 (0)	0 (0)
Nausea and vomiting of postoperation/n (%)	0 (0)	5 (25.0)
VAS of sport/score	2.3±0.7^①	3.5±2.8
Time of parecoxib sodium use/n	1.6±1.2^②	3.4±2.6
BCS/score	2.9±1.2^③	1.8±0.7
Hospital stay/d	2.5±0.6	2.8±0.5

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超声引导下颈部迷走神经阻滞联合胸椎旁阻滞在胸腔镜手术中的应用

Application of ultrasound-guided cervical vagal block combined with thoracic paravertebral block in thoracoscopy

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