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超声引导下肋横突上韧带浅面与深面阻滞胸椎旁神经的对比研究
Ultrasound-guided thoracic paravertebral nerve block in superficial versus deep superior costotransverse ligament: a comparative study of 106 cases
- 陆军军医大学学报 2022年44卷第7期 页码：711-717
- 作者机构：
400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
[鲁开智，E-mail: lukaizhi2010@163.comLU Kaizhi, E-mail: lukaizhi2010@163.com
- 基金信息：重庆市卫生适宜技术推广项目(2020jstg019)
DOI：10.16016/j.2097-0927.202109204
中图分类号： R445.1;R614.4;R655收稿：2021-09-27，
修回：2022-01-19，
纸质出版：2022-04-15
- 稿件说明：
移动端阅览
朱华丽, 吕锐, 陈妍, 等. 超声引导下肋横突上韧带浅面与深面阻滞胸椎旁神经的对比研究[J]. 陆军军医大学学报, 2022,44(7):711-717.
Huali ZHU, Rui LYU, Yan CHEN, et al. Ultrasound-guided thoracic paravertebral nerve block in superficial versus deep superior costotransverse ligament: a comparative study of 106 cases[J]. Journal of Army Medical University, 2022, 44(7): 711-717.
朱华丽, 吕锐, 陈妍, 等. 超声引导下肋横突上韧带浅面与深面阻滞胸椎旁神经的对比研究[J]. 陆军军医大学学报, 2022,44(7):711-717. DOI： 10.16016/j.2097-0927.202109204.
Huali ZHU, Rui LYU, Yan CHEN, et al. Ultrasound-guided thoracic paravertebral nerve block in superficial versus deep superior costotransverse ligament: a comparative study of 106 cases[J]. Journal of Army Medical University, 2022, 44(7): 711-717. DOI： 10.16016/j.2097-0927.202109204.
摘要
目的
2
对比超声引导下肋横突上韧带(superior costal transverse ligament，SCTL)浅面与深面注射局部麻醉药的胸椎旁神经阻滞(thoracic paravertebral block，TPVB)联合患者静脉自控镇痛(patient controlled intravenous analgesia，PCIA)用于胸腔镜手术患者术后镇痛的效果及术后恢复质量。
方法
2
按标准纳入2021年5月至2021年9月本院胸外科择期行胸腔镜手术的患者106例，采用随机数字表法分为SCTL浅面阻滞组(S组)和SCTL深面阻滞组(T组)。2组患者常规麻醉诱导和维持，术毕拔管后行超声引导下TPVB，在SCTL浅面或深面注射局部麻醉药，2组均采用0.375%盐酸罗哌卡因注射液20 mL进行患侧单点TPVB，同时采用PCIA。记录超声图像定位时间、穿刺时间、测量超声图像针尖至胸膜的距离、观察超声图像胸膜下压及穿刺相关并发症，评估阻滞后5、10、20、30 min和4、12、24 h(T
0~6
)静息和运动(咳嗽)状态下视觉模拟评分(visual analogue score，VAS)，观察术后24 h内镇痛泵使用情况(舒芬太尼用量、首次按压时间、有效按压次数、实际按压次数)以及调查术前、术后24 h 40项恢复质量(quality of recovery，QOR-40)。
结果
2
与T组相比，S组穿刺时间缩短(
P
＜0.05)，超声图像测量针尖至胸膜距离更远(
P
＜0.05)，S组有15例能在超声图像下观察到胸膜下压，T组51例能在超声图像上观察到胸膜下压(
P
＜0.05)。T组出现1例硬膜外阻滞。S组患者运动(咳嗽)状态下T
6
的VAS评分高于T组(
P
＜0.05)，由于均属于轻度疼痛评分范围，认为没有临床差异，2组患者其余各时间点静息和运动(咳嗽)状态下VAS评分、超声引导下图像定位时间、术后24 h内镇痛泵使用情况(舒芬太尼用量、首次按压时间、有效按压次数、实际按压次数)、术前和术后24 h QOR-40评分差异无统计学意义。
结论
2
超声引导下肋横突上韧带浅面或深面注药用于胸椎旁神经阻滞均可为胸腔镜手术患者提供有效的术后镇痛以及相当的术后恢复质量。肋横突上韧带可作为超声引导下胸椎旁神经阻滞的注药参照物，超声引导下肋横突上韧带浅面进行胸椎旁神经阻滞操作更加简便、快捷与安全。
Abstract
Objective
2
To compare the analgesic effect and postoperative recovery quality of ultrasound-guided superficial and deep injection to superior costal transverse ligament (SCTL) for local anesthetics in thoracic paravertebral block (TPVB) combined with patient-controlled intravenous analgesia (PCIA) for postoperative analgesia in patients undergoing thoracoscopic surgery.
Methods
2
A total of 106 patients undergoing elective thoracoscopic surgery in the thoracic surgery department of our hospital from May 2021 to September 2021 were eligible for inclusion. They were randomly divided into SCTL superficial block group (Group S) and SCTL deep block group (Group T). Routine anesthesia induction and maintenance were performed in the both groups. After extubation
TPVB was operated under the guidance of ultrasound
and corresponding analgesic agent was injected into the superficial or deep surface of SCTL for local anesthetics
with 20 mL of 0.375% ropivacaine hydrochloride for single-point TPVB on the affected side
and PCIA was given at the same time. The positioning time and puncture time of ultrasonic image were recorded
the distance from the tip of ultrasonic image needle to pleura was measured
and the pleural depression and puncture related complications of ultrasonic image were observed. Visual analogue score (VAS) in resting and exercise (cough) states was evaluated at 5
10
20 and 30 min
and 4
12 and 24 h (T
0~6
) after block. The use of analgesic pump within 24 h after operation was observed in terms of sufentanil dosage
first compression time
effective compression times
and actual compression times. QOR-40 was employed to investigate the quality of recovery before and 24 h after operation.
Results
2
Group S had significantly shorter puncture time (
P
<
0.05) and longer distance from the tip of the needle to the pleura on ultrasound image when compared with Group T (
P
<
0.05). Pleural depression could be observed in ultrasound image of 15 cases in Group S and of 51 cases in Group T (
P
<
0.05). There was 1 case of epidural block in Group T. The VAS score at T
6
in exercise (cough) state was obv
iously higher in Group S than Group T (
P
<
0.05). But
because the scores in both groups belonged to the range of mild pain score
no clinical difference was identified between the 2 groups. There were no statistical differences in the other VAS scores in resting and exercise (cough) states
time of image positioning under ultrasound guidance
and use of analgesic pump within 24 h after operation
and QOR-40 scores before and 24 h after operation between the 2 groups.
Conclusion
2
Both ultrasound-guided superficial and deep injection of analgesic drugs into SCTL for TPVB can provide effective postoperative analgesia and equivalent postoperative recovery quality for patients after thoracoscopic surgery. SCTL can be used as injection reference for ultrasound guidance. But the superficial injection of SCTL is safer
easier and simpler in operation.
关键词
Keywords
references
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