CAJ | 학술논문

目的：评价术前超声引导下胸椎旁阻滞（TPVB）对全肾切除患者术后镇痛效果和恶心呕吐（PONV）发生率的影响。方法前瞻性随机对照研究，对40名行全肾切除的患者，随机分为 TPVB 组（S 组）和静脉 PCA 组（C 组），每组20例。S 组患者在术前接受超声引导下 TPVB 阻滞（T9-T11），每个节段注射0．5％罗哌卡因5 ml。所有患者接受全麻下全肾切除手术。研究终点为术后12 h 内疼痛视觉模拟评分（VAS），术中芬太尼用量，术后吗啡累计用量以及术后恶心呕吐（PONV）发生率。结果S 组在术后2 h、4 h、6 h 和12 h 的活动 VAS 评分均低于 C 组（P ＜0．05）；患者首次使用 PCA 吗啡补救镇痛的时间，S 组晚于 C 组（185±48 min v．s．50±38 min，P ＜0．05）；术后24 h 吗啡累计用量降低（22±8．5 mg vs．68±17．3 mg，P ＜0．05）；术中芬太尼用量，S 组低于 C 组（2．5±0．8μg／kg v．s．4．8±1．1μg／kg，P ＜0．05）。PONV 发生率 S 组低于 C 组（23％ v．s．53％，P ＜0．05）。结论对于全肾切除术，术前超声引导在 T9-T11进行单次 TPVB，能够产生良好的术后镇痛效果，降低阿片类用量和 PONV 发生率。
목적：평개술전초성인도하흉추방조체（TPVB）대전신절제환자술후진통효과화악심구토（PONV）발생솔적영향。방법전첨성수궤대조연구，대40명행전신절제적환자，수궤분위 TPVB 조（S 조）화정맥 PCA 조（C 조），매조20례。S 조환자재술전접수초성인도하 TPVB 조체（T9-T11），매개절단주사0．5％라고잡인5 ml。소유환자접수전마하전신절제수술。연구종점위술후12 h 내동통시각모의평분（VAS），술중분태니용량，술후마배루계용량이급술후악심구토（PONV）발생솔。결과S 조재술후2 h、4 h、6 h 화12 h 적활동 VAS 평분균저우 C 조（P ＜0．05）；환자수차사용 PCA 마배보구진통적시간，S 조만우 C 조（185±48 min v．s．50±38 min，P ＜0．05）；술후24 h 마배루계용량강저（22±8．5 mg vs．68±17．3 mg，P ＜0．05）；술중분태니용량，S 조저우 C 조（2．5±0．8μg／kg v．s．4．8±1．1μg／kg，P ＜0．05）。PONV 발생솔 S 조저우 C 조（23％ v．s．53％，P ＜0．05）。결론대우전신절제술，술전초성인도재 T9-T11진행단차 TPVB，능구산생량호적술후진통효과，강저아편류용량화 PONV 발생솔。
Objective To evaluate the effects of ultrasound-guided thoracic paravertebral block (TPVB)on analgesia and postoperative nausea and vomiting (PONV)in patients undergoing nephrectomy.Methods a prospective random-ized controlled study.40 patients scheduled for nephrectomy were randomly assigned into two groups:Group S (TPVB),and Group C (PCA morphine).Group S received ultrasound-guided thoracic paravertebral block at T9-T11 levels,with 5ml of 0.5% ropivocaine at each level.All patients received general anesthesia and nephrectomy in the OR. Patients were assessed for postoperative pain score (VAS).Intraoperative fentanyl consumption and postoperative mor-phine consumption were recorded.The incidence of PONV was recorded.Patients were followed-up for any complica-tions during their hospital stay.Results Group S showed significant decrease in dynamic VAS scores within postopera-tive 12 hours (P <0.05),less consumption of intraoperative fentanyl (P <0.05),and less postoperative morphine (P <0.05).Group S showed a later time of the first dose rescue morphine (P < 0.01),and lower PONV incidence(P <0.05).Conclusion Ultrasound-guided TPVB results in greater postoperative analgesic effects,reduced opioids con-sumption and PONV incidence in patients undergoing nephrectomy.