微创医学

目的对比超声引导两点与单点胸椎旁神经阻滞(TPVB)联合全身麻醉在胸腔镜肺叶切除术患者中应用的临床疗效。方法选择行胸腔镜肺叶切除术患者64例，采用随机数字表法分为单点组（n=32）和两点组（n=32)。单点组在全身麻醉诱导前于第5胸椎行TPVB，两点组在全身麻醉诱导前分别于第4、第7胸椎行TPVB。术中采用全凭静脉麻醉，维持心率、血压于术前基础值的20%左右。比较两组TPVB的操作时间、阻滞平面，术中舒芬太尼、丙泊酚的总用量，麻醉恢复室（PACU）期间舒芬太尼的用量及停留时间，术后不同时点的VAS评分，术后48 h患者自控静脉镇痛（PCIA）泵按压次数，以及并发症发生率。结果两点组患者TPVB的操作时间长于单点组，阻滞平面优于单点组；两点组术中舒芬太尼总用量、丙泊酚总用量、PACU舒芬太尼用量均少于单点组(均P＜0.05)，但两组PACU停留时间的差异无统计学意义（P＞0.05）；两点组术后2 h、4 h、8 h、12 h的VAS评分低于单点组(均P＜0.05)，术后24 h、36 h、48 h的VAS评分差异无统计学意义(均P＞0.05)；两点组术后48 h PCIA按压次数少于单点组(P＜0.05)；两组包括恶心、呕吐、气胸、呼吸抑制在内的总并发症发生率差异无统计学意义(P＞0.05)。结论与单点TPVB相比，两点TPVB在胸腔镜肺叶切除术中阻滞平面更广、镇痛效果更优、阿片类镇痛药用量更少，值得临床推广。

ObjectiveTo compare the clinical efficacy of ultrasound-guided double-level with single-level thoracic paravertebral nerve block (TPVB) combined with general anesthesia in the application of thoracoscopic pulmonary lobectomy. MethodsA total of 64 patients undergoing thoracoscopic pulmonary lobectomy were enrolled, and they were assigned to single-level group (n=32) and double-level group (n=32) according to the random number method. The single-level group underwent TPVB on 5th thoracic vertebra before induction of general anesthesia, and the double-level group received TPVB on the 4th and 7th thoracic vertebra before induction of general anesthesia, respectively. Total intravenous anesthesia was employed during operation, the heart rate and pressure were maintained at around 20% of the preoperative base values. The TPVB operating time and the levels of plane block, intraoperative total doses of sufentanil and propofol, doses of sufentanil and duration of staying in the postanesthesia care unit (PACU), postoperative VAS scores at different time points, patient controlled intravenous analgesia (PCIA) pump times 48 hours after operation, and the incidence of complications were compared between the two groups. ResultsCompared to the single-level group, the double-level group yielded longer operating time but a superior block level, and less intraoperative total doses of sufentanil and propofol, as well as the dose of sufentanil in PACU (all P＜0.05); however, there was no statistically significant difference of duration of staying in PACU between the two groups (P＞0.05). The double-level group interpreted lower VAS scores 2, 4, 8, and 12 hours after operation as compared with the single-level group (all P＜0.05), whereas no statistically significant difference of VAS scores was showed 24, 36, and 48 hours after operation between the two groups (all P＞0.05). The PCIA pump times 48 hours after operation were less in the double-level group than in the single-level group (P＜0.05). There was no statistically significant difference of the total complications incidence, including nausea, vomiting, pneumothorax, respiratory depression (P＞0.05). ConclusionCompared with single-level TPVB, double-level TPVB blocks a wider plane in thoracoscopic pulmonary lobectomy, and has superior analgesia effects, uses less doses of opioid analgesics, and thus it is worthy of clinical promotion.