CAJ | 학술논문

目的比较超声引导下单次注射不同浓度罗哌卡因胸椎旁阻滞联合患者自控静脉镇痛( PCIA)对胸腔镜手术的术后镇痛效果. 方法 86例行胸腔镜手术的患者,A组患者术前予0. 5%罗哌卡因20mL单次胸椎旁阻滞后,术后行常规PCIA镇痛(n=28);B组术前给予0. 375%罗哌卡因20mL单次胸椎旁阻滞后,行术后常规PCIA镇痛(n=30);C组术后给予常规PCIA镇痛(对照组,n=28). 记录入室后(T0)、阻滞后15min(T1)、插管后(T2)、切皮后5min(T3)、拔管前(T4)患者HR和MAP. 记录阻滞平面、术后1、6、12、24、36、48h的VAS评分、术后48h舒芬太尼消耗量、患者满意度和不良反应发生情况. 结果三组各时点HR和MAP比较差异无统计学意义(P>0. 05). 术后各时点A、B两组VAS评分和48h舒芬太尼消耗量,均明显低于C组(P<0. 01);患者满意度、不良反应发生情况,A组和B组均明显优于C组;A、B两组上述指标比较,差异无统计学意义(P>0. 05). 结论超声引导下不同浓度罗哌卡因单次胸椎旁阻滞联合PCIA镇痛,在减轻胸腔镜手术患者术后疼痛、降低舒芬太尼消耗量和镇痛药物不良反应方面均明显优于常规PCIA镇痛,且效果相当.
목적 비교초성인도하단차주사불동농도라고잡인흉추방조체연합환자자공정맥진통( PCIA)대흉강경수술적술후진통효과. 방법 86례행흉강경수술적환자,A조환자술전여0. 5%라고잡인20mL단차흉추방조체후,술후행상규PCIA진통(n=28);B조술전급여0. 375%라고잡인20mL단차흉추방조체후,행술후상규PCIA진통(n=30);C조술후급여상규PCIA진통(대조조,n=28). 기록입실후(T0)、조체후15min(T1)、삽관후(T2)、절피후5min(T3)、발관전(T4)환자HR화MAP. 기록조체평면、술후1、6、12、24、36、48h적VAS평분、술후48h서분태니소모량、환자만의도화불량반응발생정황. 결과 삼조각시점HR화MAP비교차이무통계학의의(P>0. 05). 술후각시점A、B량조VAS평분화48h서분태니소모량,균명현저우C조(P<0. 01);환자만의도、불량반응발생정황,A조화B조균명현우우C조;A、B량조상술지표비교,차이무통계학의의(P>0. 05). 결론 초성인도하불동농도라고잡인단차흉추방조체연합PCIA진통,재감경흉강경수술환자술후동통、강저서분태니소모량화진통약물불량반응방면균명현우우상규PCIA진통,차효과상당.
Objective To compare the analgesic efficacy of single-injection thoracic paravertebral block( TPVB) with dif-ferent concentration ropivacaine in patients undergoing video-assisted thoracoscopic surgery. Methods Eighty-six patients under-going video-assisted thoracoscopic surgery were randomly administered different analgesia treatment:patients in group A (n=28) and group B (n=30)were underwent untrasound-guided TPVB with a preoperative sigle-injection of 20 mL of 0. 5%(group A) or 0. 375%( group B) ropivacaine and postoperative PCIA analgesia with 100μg of sufentanil. Patients in group C received postopera-tive PCIA analgesia with 100ug of sufentanil. HR, MAP and the numbers of anesthetized dermatomes were recorded. VAS scores at 1,6,12,24,36 and 48h postoperatively were compared among the three groups. Sufentanil consumption within 48 h,adverse effects and patient satisfaction were evaluated. Results There were no difference in HR and MAP among the three groups. Simi-lar VAS were shown between group A and group B at 1,6,12,24,36 and 48h postoperatively,which were significantly lower than that in group C(P<0. 01). Compared with patients group C,patients in group A and group B had less sufentaniless consumption within 48h and were more satisfied in analgesia efficacy with less adverse effects. Conclusion Compared with conventional PCIA treatment,single-injection TPVB with different concentration of ropivacaine combined with PCIA analgesia presented better postop-erative analgesic efficacy with less adverse effects in patients undergoing video-assisted thoracoscopic surgery. Different concentra-tion of ropivacaine (0. 5% or 0. 375%) had similar analgesic efficacy in this subset of patients.