| 摘要: |
| 探讨超声引导单点单次胸椎旁阻滞（ThPVB）对经皮肾镜碎石术（PCNL）后镇痛效果和吗啡消耗量的影响。方法：选择行择期PCNL患者50例，随机分ThPVB组（P组）和对照组（C组）。P组于术毕在Sonosite M-Turbo彩色超声诊断仪引导下，于T11胸椎旁间隙注入0.5 %罗哌卡因（耐乐品）10 mL；C组不行胸椎旁阻滞。两组术后均使用吗啡自控镇痛泵，记录麻醉诱导前、术中和术后的心率（HR）、外周脉搏氧饱和度（SPO2）、呼吸频率（RR）和无创血压（BP），记录拔除气管导管后24 h内的NRS评分、RR、Ramsey 镇静评分，同时记录拔除气管导管后24 h吗啡总消耗量、不良反应和患者满意度。结果：P组拔除气管导管后0.5 h、1 h、2 h、4 h、8 h、12 h和24 h的NRS评分分别为1.4±1.4、1.9±1.3、2.2±1.4、2.3±1.0、2.4±1.6、1.9±0.9、1.6±0.9，相同时间点静息NRS评分分别为0.3±0.7、0.7±0.9、0.9±1.0、1.1±0.9、1.0±1.0、0.6±0.7、0.4±0.6，低于C组(P<0.05 或P< 0.01 )。P组拔管后24 h内各个时间点的Ramsay镇静评分与C组相比，差异无统计学意义（P>0.05）。P组术后24 h的吗啡总消耗量为（4.5±2.3）mg，C组为（9.2±4.9）mg(P<0.01)。P组、C组的患者“非常满意”度分别占80.0%和23.6%（P<0.05）。结论：ThPVB可以为接受PCNL手术的患者提供良好的术后镇痛，并提高患者的镇痛满意度。 |
| 关键词: 胸椎旁阻滞 超声引导 术后镇痛 经皮肾镜碎石术 |
| DOI：10.3969/j.issn.1007-6948.2019.01.009 |
|
| 基金项目:广东省深圳市卫计委科研项目（201507058） |
|
| Ultrasound-guided Thoracic Paravertebral Block on Postoperative Analgesia after Percutaneous Nephrolithotomy |
| CHEN Xiao-wei,XU Xue-bing,LI Xuan-ying,NIU Qiang,SHI Xiaoyong,CHEN Youwei |
| Department of Anaesthesiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen(518053), China |
| Abstract: |
| Objective To investigate the effect of ultrasound-guided single-point single-dose thoracic paravertebral block (ThPVB) on analgesia effect and morphine consumption in patients undergoing percutaneous nephrolithotomy (PCNL). Methods 50 patients scheduled for elective percutaneous nephrolithotomy were randomized into ThPVB group ( Group P) and Control group ( Group C). After the procedure, in the group P, a single-shot ThPVB with 0.5% ropivacaine (Naropin) 10ml was performed at the T11 thoracic paravertebral space under the guidance of Sonosite M-Turbo. ThPVB was not performed in group C. patients in both groups received patient-controlled analgesia service with morphine. Heart rate (HR), peripheral pulse oxygen saturation (SPO2), respiratory rate (RR) and noninvasive blood pressure (BP) before the anesthesia, during and after the procedure were recorded . The NRS score, RR, and Ramsey sedation score 24 h after tracheal extubation were recorded, as well as the total consumption of morphine (MC) , adverse reactions , patient satisfaction (Level of Satisfaction, LOS). Results The movement NRS score of patients in group P was 1.4±1.4, 1.9±1.3, 2.2±1.4, 2.3±1.0, 2.4±1.6, 1.9±0.9 and1.6±0.9， at 0.5h, 1 h, 2h, 4 h, 8 h, 12 h and 24 h after extubation respectively. The rest NRS score at the same time point was 0.3±0.7, 0.7±0.9, 0.9±1.0, 1.1± 0.9,1.0±1.0, 0.6±0.7 and0.4±0.6 respectively. Both movement and rest NRS scores in group P were lower than that of the group C (P<0.05 Or P<0.01). The Ramsay sedation score at each time point within 24 hours after extubation in group P was not significantly different from the same time point in group C. The MC of 24 hours after operation in group P was (4.5±2.3) mg, which was less than that of group C (9.2±4.9) mg (P<0.001). The level “very satisfied” accounted for 80% and 23.6% in Group P and Group C respectively. Conclusion For patients undergoing PCNL, ThPVB is effective in decreasing postoperative pain and can improve the postoperative satisfaction for patients. |
| Key words: Thoracic paravertebral block ultrasound-guided postoperative analgesia percutaneous nephrolithotomy |
