胸腔镜下椎旁间隙置管镇痛在胸腔镜肺叶切除手术中的应用

Application of thoracoscopic paravertebral space catheter analgesia in thoracoscopic lobectomy

摘要:

目的 评价胸腔镜下椎旁间隙置管持续椎旁神经阻滞在胸腔镜肺叶切除手术后镇痛中的应用价值。方法 选取胸腔镜肺叶切除手术患者68例，根据置管方式不同分为实验组（胸腔镜下椎旁间隙置管镇痛组）35例和对照组（超声引导下椎旁间隙置管镇痛组）33例。置管成功后，两组均经导管注入0.5%罗哌卡因20 mL作为负荷量，术后以2 mL/h的速度持续泵入0.15%罗哌卡因。比较两组术后不同时间点的疼痛程度、镇痛副作用及肺部并发症发生情况。结果 在静止状态及咳嗽时，两组术后2、4、6、8、12、24和48 h的视觉模拟评分（VAS）比较，差异均无统计学意义（P > 0.05）。两组均有患者出现头晕嗜睡、恶心呕吐和低血压等镇痛相关副作用，但两组比较，差异无统计学意义（P > 0.05）。两组肺部并发症比较，差异无统计学意义。没有观察到与麻醉镇痛相关的严重并发症。结论 胸腔镜下椎旁间隙置管用于术后持续椎旁神经阻滞镇痛中，安全、有效、可行，且并发症发生率低，操作简单易学，无需超声设备辅助。

Abstract:

Objective To determine the application value of using the thoracoscopic catheter-insertion technique in the continuous paravertebral block for releasing the postoperative pain after video-assisted thoracoscopic surgery lobectomy.Methods Participants were 68 patients after video-assisted thoracoscopic surgery (VATS) lobectomy. They were divided into two groups: experimental group (n = 35) that received thoracoscopic-guided paravertebral block, and control group (n = 33) that received ultrasound-guided paravertebral block, according to different catheterization methods. After successful catheterization, 20 mL 0.5% Ropivacaine was injected through the catheter as a load in both groups, and 0.15% Ropivacaine was continuously pumped into the paravertebral space with 2 mL/h, after the operation. The research compared the pain degree, side effects of analgesia, and pulmonary complications after the surgery in the two groups at different times.Results In the static state and cough state, there was no significant difference in VAS scores between the experimental and control groups at 2 h, 4 h, 6 h, 8 h, 12 h, 24 h, and 48 h after the operation (P > 0.05). In terms of side effects related to analgesia, there were uncomfortable symptoms such as dizziness, drowsiness, nausea, vomiting, hypotension in both the experimental and control groups, and the incidence rate in the two groups showed no statistical significance (P > 0.05). Regarding pulmonary complications, there was no significant difference between the two groups (P > 0.05). No severe complications related to anesthesia were observed.Conclusion Continuous paravertebral block using a thoracoscopic catheter-insertion technique is safe and effective for release postoperative pain after video-assisted thoracoscopic surgery lobectomy, with few complication and easy operation, without the support of ultrasound.