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《肋間神經(jīng)阻滯在胸腔鏡自發(fā)性氣胸術(shù)后鎮(zhèn)痛應(yīng)用》由會員上傳分享，免費在線閱讀，更多相關(guān)內(nèi)容在學(xué)術(shù)論文-天天文庫。
1、北京醫(yī)學(xué)2015年第37卷第6期·561··論著·肋間神經(jīng)阻滯在胸腔鏡自發(fā)性氣胸術(shù)后鎮(zhèn)痛的應(yīng)用李萌黃朝宇郭濤武寬韓哲【摘要】目的探討肋間神經(jīng)阻滯在電視輔助胸腔鏡（VATS）自發(fā)性氣胸術(shù)后鎮(zhèn)痛的應(yīng)用價值。方法120例自發(fā)性氣胸患者均接受擇期患側(cè)單操作孔VATS探查和肺大皰切除術(shù)，隨機(jī)分為3組：A組為單純肋間神經(jīng)阻滯組，采用0.375%羅哌卡因5ml在切口所在肋間及其上下各1個肋間的椎旁阻滯肋間神經(jīng)；B組為肋間神經(jīng)阻滯+經(jīng)靜脈患者自控鎮(zhèn)痛（patientcontrolledintravenousanalgesia,PCIA）組，方案為氟比洛芬酯注射液200m
2、g+芬太尼20μg/kg+鹽酸昂丹司瓊注射液16mg；C組為單純PCIA，方案同B組。觀察并記錄3組患者術(shù)后2、6、24、48h（T1~T4）在靜息狀態(tài)和活動狀態(tài)下的視覺模擬評分（VAS評分）；記錄B組和C組術(shù)后各時段靜脈鎮(zhèn)痛泵用量，及額外要求注射鹽酸哌替啶的患者例數(shù)及用量。結(jié)果除A組T3時點靜息狀態(tài)外，A組和B組患者在術(shù)后T1~T3時點靜息及活動狀態(tài)的VAS評分明顯低于C組（P＜0.05），尤以T1和T2時點為明顯；T4時點B組和C組的VAS評分低于A組（P＜0.05），但B、C組間的差異無統(tǒng)計學(xué)意義。結(jié)論肋間神經(jīng)阻滯+PCIA是胸腔鏡自發(fā)性氣胸手術(shù)后
3、比較滿意的鎮(zhèn)痛方案，肋間神經(jīng)阻滯對胸腔鏡自發(fā)性氣胸手術(shù)后24h內(nèi)的急性疼痛的鎮(zhèn)痛效果明顯優(yōu)于單純PCIA?！娟P(guān)鍵詞】肋間神經(jīng)阻滯自發(fā)性氣胸電視胸腔鏡視覺模擬評分法靜脈自控鎮(zhèn)痛ApplicationofintercostalnerveblockforpostoperativeanalgesiaafterbullactomyviaVTASfortreatingspontaneouspneumothoraxLiMeng,HuangZhaoyu,GuoTao,WuKuan,HanZhe.AnesthesiaDepartment,BeijingHaidianHos
4、pital,Beijing100080,ChinaCorrespondingauthor：GuoTao，Email：guotaoyuer@sohu.com【Abstract】ObjectiveTostudytheeffectofintercostalnerveblockforpostoperativeanalgesiaafterbullactomyviaVTASfortreatingspontaneouspneumothorax.MethodsOnehundredandtwentypatientswithspontaneouspneumo-thoraxw
5、hounderwentselectiveoperationsnamed“exploratorysurgeryandbullactomyviaVATSbysingleoperationchannel”andwererandomlydividedinto3groups:groupA:treatedonlybyintercastalnerveblock（5mlof0.375%ropi-vacainewasinjectedintotherootsofintercoastalneverswhichlocatedatthesideofthoracicvertebra
6、eandsupplythecutanditssurroundingsaswell）;groupB:treatedbyintercastalnerveblockcombinedwithPCIA（Thedrugconsistedofflur-biprofen200mgmixedwithfentanyl20μg/kgandondansetron16mg）;groupC:treatedonlybyPCIA.Allthepatientsofthe3groupswerefollowedupandevaluatedatthetimeof2,6,24and48hafte
7、rtheoperationwhenevertheywereatrestorduringexertion.TheevaluationcriteriawasaccordingtoVAS.Thenumberofthepatientswhohadbeeninjecteddolan-tinforrelievingpainwasrecorded.Besides,thedosagesofPCIAfromgroupBandgroupCwerecompletelyrecordedaswell.ResultsTheVASofgroupAandgroupBwassignifi
8、cantlylowerthanthatofgroupCinthefirst24h
