CAJ | 학술논문

目的：评价肾切除术后采用连续椎旁神经阻滞镇痛的疗效。方法选择2012年2月至2013年11月杭州市中医院泌尿外科拟行单纯性肾脏切除术患者60例，美国麻醉医师协会（ ASA）分级Ⅰ～Ⅱ级，年龄30～65岁，体质量45～80 kg，性别不限，经医院伦理委员会审核通过。采用随机数字表法，将患者随机分为2组：硬膜外阻滞组（ CEA 组）及连续椎旁神经阻滞组（ PVB组），每组30例。两组均连续输注0.2％罗哌卡因250 ml，并采用静脉吗啡患者自控辅助镇痛。于术后6、12、24及48 h分别检测血气，并评估安静和运动状态时的视觉模拟评分（ VAS），统计术后48 h两组患者吗啡累计用量及并发症的发生率。结果与CEA组相比， PVB组PaO2明显升高，PaCO2明显降低，运动VAS评分明显降低，吗啡累积用量减少[（5.2±1.2）比（13.9±1.6）mg]，恶心、呕吐、皮肤瘙痒、体位性低血压患者数明显减少，术毕至首次肛门排气的时间间隔短（P＜0.05），而两组各点安静VAS评分差异无统计学意义。结论开放性肾切除术后采用PVB镇痛较CEA镇痛可减少术后吗啡用量及相关并发症，有利于患者恢复。
목적：평개신절제술후채용련속추방신경조체진통적료효。방법선택2012년2월지2013년11월항주시중의원비뇨외과의행단순성신장절제술환자60례，미국마취의사협회（ ASA）분급Ⅰ～Ⅱ급，년령30～65세，체질량45～80 kg，성별불한，경의원윤리위원회심핵통과。채용수궤수자표법，장환자수궤분위2조：경막외조체조（ CEA 조）급련속추방신경조체조（ PVB조），매조30례。량조균련속수주0.2％라고잡인250 ml，병채용정맥마배환자자공보조진통。우술후6、12、24급48 h분별검측혈기，병평고안정화운동상태시적시각모의평분（ VAS），통계술후48 h량조환자마배루계용량급병발증적발생솔。결과여CEA조상비， PVB조PaO2명현승고，PaCO2명현강저，운동VAS평분명현강저，마배루적용량감소[（5.2±1.2）비（13.9±1.6）mg]，악심、구토、피부소양、체위성저혈압환자수명현감소，술필지수차항문배기적시간간격단（P＜0.05），이량조각점안정VAS평분차이무통계학의의。결론개방성신절제술후채용PVB진통교CEA진통가감소술후마배용량급상관병발증，유리우환자회복。
Objective To evaluate the effects of continuous paravertebral nerve block after nephrectomy.Methods 60 cases receiving simple nephrectomy , American Society of Anesthesiologists (ASA) grading status Ⅰor Ⅱ, aged from 30 to 65 years, weighing from 45 to 80 kg, male or female,were randomly divided into 2 groups:control group ( CEA group ) and continuous paravertebral nerve block group ( PVB group ) , 30 patients in each one.Both groups were performed with 0.2% ropivacaine 250 ml in continuous infusion , assisted with intravenous morphine patient-controlled analgesia.The blood gas was examined in 6,12,24 and 48 h postoperatively, and the VAS scores of quiet state and motion state were assessed.In 48 h postoperation ,the total amount of morphine was calculated and the complications cases were recorded.Results Compared with the CEA group , PaO2 in PVB group increased and PaCO 2 declined significantly.There was no difference of VAS score under quiet state , but under the motion state the VAS scores declined significantly,the total amount of morphine reduced [(5.2 ±1.2) vs (13.9 ±1.6)mg)], the cases of nausea , vomiting , pruritus , orthostatic hypotension decreased and the postoperative first anal exhaust time interval shortened (P<0.05).Conclusion Compared with CEA,postoperative administration of PVB for open nephrectomy results in lowering morphine dose as well as side effect related with the use of morphine.