CAJ | 학술논문

目的：探讨肋间神经阻滞在婴幼儿开胸术后镇痛中的应用效果及对呼吸功能的影响。方法将83例先天性心脏病（左向右分流）行开胸手术的患儿按随机数字表法分为对照组（n＝40）和观察组（n＝43）。2组患儿手术及麻醉过程均相同，观察组在关胸前10 min 进行肋间神经阻滞，在切口相应的肋间及切口上下各一肋间神经根旁按1．0 mL·kg－1注射0．1％布比卡因＋芬太尼0．1μg·kg－1；对照组不注入任何药物。采用婴幼儿 FLACC 评分法对2组患儿术后2、6、12、24及48 h 镇痛效果进行评分；观察2组麻醉后手术前，手术后2、6、12、24及48 h 各时间点的氧合指数（OI）和呼吸指数（RI）变化。结果所有患儿手术均顺利完成。观察组术后2、6、12 h FLACC 评分明显低于对照组（均 P ＝0．000），2组术后24、48 h FLACC 评分比较差异均无统计学意义（均 P ＞0．05）。2组患儿术后2、6、12 h OI 和 RI 比较差异均无统计学意义（均 P ＞0．05）；观察组术后24、48 h 的 OI 明显高于对照组，RI 明显低于对照组（均 P ＜0．05）。结论婴幼儿开胸术应用肋间神经阻滞在术后早期有明显的镇痛效果，对患儿呼吸功能具有保护作用。
목적：탐토륵간신경조체재영유인개흉술후진통중적응용효과급대호흡공능적영향。방법장83례선천성심장병（좌향우분류）행개흉수술적환인안수궤수자표법분위대조조（n＝40）화관찰조（n＝43）。2조환인수술급마취과정균상동，관찰조재관흉전10 min 진행륵간신경조체，재절구상응적륵간급절구상하각일륵간신경근방안1．0 mL·kg－1주사0．1％포비잡인＋분태니0．1μg·kg－1；대조조불주입임하약물。채용영유인 FLACC 평분법대2조환인술후2、6、12、24급48 h 진통효과진행평분；관찰2조마취후수술전，수술후2、6、12、24급48 h 각시간점적양합지수（OI）화호흡지수（RI）변화。결과소유환인수술균순리완성。관찰조술후2、6、12 h FLACC 평분명현저우대조조（균 P ＝0．000），2조술후24、48 h FLACC 평분비교차이균무통계학의의（균 P ＞0．05）。2조환인술후2、6、12 h OI 화 RI 비교차이균무통계학의의（균 P ＞0．05）；관찰조술후24、48 h 적 OI 명현고우대조조，RI 명현저우대조조（균 P ＜0．05）。결론영유인개흉술응용륵간신경조체재술후조기유명현적진통효과，대환인호흡공능구유보호작용。
Objective To investigate the efficacy of intercostal nerve block for analgesia after thoracotomy and its effect on respiratory function in infants and young children.Methods A total of 83 infants and young children with congenital heart disease(left to right shunts)were randomly divided into two groups after the same anesthesia and thoracotomy.The observation group (n=43)was given intercostal nerve block 10 minutes before chest closure with injection of 0.1%bupivacaine plus 0.1 μg·kg-1 fentanyl(1.0 mL·kg-1 ).The control group(n=40)received no drug injection.The analgesic effect was evaluated using the FLACC scale at 2,6,12,24 and 48 hours after operation.The oxygenation index(OI)and respiratory index(RI)were calculated after the beginning of anesthesia and at 2,6,12,24 and 48 hours after operation.Results All opera-tions were performed successfully.Compared with control group,intercostal nerve block induced a decrease in FLACC score at 2,6 and 12 hours after operation,an increase in OI at 24 and 48 hours after operation,and a reduction in RI at 24 and 48 hours after operation(P <0.05).No significant differences were found between the two groups in FLACC score at 24 and 48 hours after opera-tion,as well as in OI and RI at 2,6 and 12 hours after operation(P >0.05).Conclusion Intercos-tal nerve block has obvious analgesic effect in the early postoperative period and plays a protective role in respiratory function after thoracotomy in infants and young children.