超声引导胸椎旁神经阻滞复合PCIA在开腹肝脏部分切除手术后镇痛中的应用：一项随机对照试验

冉伟; 郝涌刚; 吴刚明

doi:10.16016/j.2097-0927.202308100

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超声引导胸椎旁神经阻滞复合PCIA在开腹肝脏部分切除手术后镇痛中的应用：一项随机对照试验

临床医学 | 更新时间：2026-01-09

- 超声引导胸椎旁神经阻滞复合PCIA在开腹肝脏部分切除手术后镇痛中的应用：一项随机对照试验
- Application of ultrasound-guided thoracic paravertebral nerve block combined with PCIA for postoperative analgesia of open partial hepatectomy: a randomized controlled trial
- 陆军军医大学学报 2024年46卷第17期页码：2009-2015
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院麻醉科
- 作者简介：
  
  [郝涌刚，E-mail：haoyg520@163.com HAO Yonggang, E-mail: haoyg520@163.com
- 基金信息：
  
  重庆市科卫联合医学科研项目(2020FYYX236)
- DOI：10.16016/j.2097-0927.202308100
  中图分类号： R614.24;R614.41;R657.7
- 收稿：2023-08-27，
  
  修回：2024-05-13，
  
  纸质出版：2024-09-15
- 稿件说明：
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冉伟, 郝涌刚, 吴刚明. 超声引导胸椎旁神经阻滞复合PCIA在开腹肝脏部分切除手术后镇痛中的应用：一项随机对照试验[J]. 陆军军医大学学报, 2024,46(17):2009-2015.

Wei RAN, Yonggang HAO, Gangming WU. Application of ultrasound-guided thoracic paravertebral nerve block combined with PCIA for postoperative analgesia of open partial hepatectomy: a randomized controlled trial[J]. Journal of Army Medical University, 2024, 46(17): 2009-2015.
冉伟, 郝涌刚, 吴刚明. 超声引导胸椎旁神经阻滞复合PCIA在开腹肝脏部分切除手术后镇痛中的应用：一项随机对照试验[J]. 陆军军医大学学报, 2024,46(17):2009-2015. DOI： 10.16016/j.2097-0927.202308100.

Wei RAN, Yonggang HAO, Gangming WU. Application of ultrasound-guided thoracic paravertebral nerve block combined with PCIA for postoperative analgesia of open partial hepatectomy: a randomized controlled trial[J]. Journal of Army Medical University, 2024, 46(17): 2009-2015. DOI： 10.16016/j.2097-0927.202308100.

摘要

目的

比较超声引导胸椎旁神经阻滞(thoracic paravertebral block

TPVB)复合患者自控静脉镇痛(patient-controlled intravenous analgesia

PCIA)与单纯患者自控静脉镇痛用于开腹肝脏部分切除手术术后镇痛的效果。

方法

选择重庆医科大学附属第一医院2020年9月至2022年9月择期行开腹肝脏部分切除手术患者120例

采用电脑随机数字法将奇数号分入超声引导胸椎旁神经阻滞复合PCIA组(A组)，偶数号分入单纯患者自控静脉镇痛组(B组)，每组60例，最终纳入符合标准的患者112例并完成统计分析。A组患者麻醉诱导前于左侧卧位行超声引导下T8~T9节段胸椎旁神经阻滞，注射0.33%罗哌卡因30 mL，B组患者不行超声引导胸椎旁神经阻滞，2组患者术后均连接PCIA镇痛泵。主要观察指标为2组患者术后4、8、12、24、48 h痛觉减退平面以及静息和活动时VAS疼痛评分；次要观察指标为术中平均心率和平均动脉压力、术后首次补救镇痛需求时间、术后48 h补救镇痛人数、术后首次下地活动时间、术后肛门排气时间、术后总住院天数以及术后不良反应发生率。

结果

与B组患者比较

A组患者术后4、8、12、24 h静息及咳嗽VAS评分降低(

0.001)，术中平均心率、平均动脉血压明显降低(

0.01)；48 h内曲马多累计消耗量减少(

=0.018)

术后首次补救镇痛需求时间延长(

0.001)；术后PCIA平均有效按压次数、补救镇痛人数均明显减少(

0.001)；首次下地活动时间和肛门排气时间显著提前(

0.001)。患者术后48 h VAS评分、术后总住院天数及术后不良反应发生率差异无统计学意义。

结论

超声引导胸椎旁神经阻滞复合PCIA在开腹肝部分切除术后镇痛效果优于单纯PCIA，术中循环更稳定，促进术后快速康复。

Abstract

Objective

To compare the analgesic efficacy of combined ultrasound-guided thoracic paravertebral block (TPVB) with patient-controlled intravenous analgesia (PCIA) versus simple PCIA after open partial hepatic resection.

Methods

A total of 120 patients undergoing elective open partial liver resection in our hospital from September 2020 to September 2022 were prospectively recruited

and then randomly divided into the TPVB+PCIA group (Group A) and simple PCIA group (Group B)

with 60 patients in each group. Finally

there were 112 patients meeting the criteria and completing statistical analysis. The patients in Group A underwent TPVB at T8~T9 in the left lateral position before anesthesia induction

with injection of 0.33% 30 mL ropivacaine. The patients in Group B had no above treatment. Both groups were given PCIA analgesia pump after surgery. The main outcome measures were analgesia levels at 4

24 and 48 h after surgery and VAS pain scores at rest and activity. The secondary outcome measures included mean ventricular rate and mean arterial pressure during operation

time required for the first postoperative analgesia relief

number of patients for the first postoperative analgesia relief 48 h after the operation

time for the first postoperative ground exercise

time for postoperative anal exhaust

total number of postoperative hospital days

and incidence of postoperative adverse reactions.

Results

Compared with the patients of Group B

those of Group A had significantly lower scores of resting VAS and exercise VAS scores at 4

12 and 24 h after operation (

0.001)

decreased mean heart rate and mean arterial blood pressure during operation (

0.01)

less cumulative consumption of tramadol within 48 h (

=0.018)

extended time for first postoperative analgesic need (

0.001)

decreased average number of PCIA effective compressions and number of relief analgesia (

0.001)

and advanced time of first ground movement and anal exhaust (

0.001). But

there were no significant differences in VAS scores at 48 h after surgery

total length of postoperative hospital stay and incidence of postoperative adverse reactions between the 2 groups.

Conclusion

Combined TPVB+PCIA shows better analgesic effect than simple PCIA for open partial hepatectomy

and it can obtain more stable intraoperative circulation and promote rapid postoperative recovery.

关键词

Keywords

references

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