【摘要】 目的 比较胸椎旁神经阻滞(TPVB)与竖脊肌平面阻滞(ESPB)在腹腔镜胆囊切除术(LC)后的镇痛效果。方法 选择2023年6月至2024年6月我院择期行LC的患者80例，年龄18～64岁，体质指数(BMI) 18.4～31.0 kg/m~2,ASA分级Ⅰ～Ⅱ级。采用随机数字表法分为TPVB和ESPB组，每组40例，最终77例患者纳入统计分析。两组患者分别在麻醉诱导前行TPVB或ESPB,选择胸7横突水平，每侧注射0.5%罗哌卡因20 ml。记录拔管后30 min、术后2、4、8、12、24 h的VAS评分。记录入室时、切皮时、胆囊操作时、苏醒时的心率(HR)、平均动脉压(MAP)。记录术中阿片类药物使用量、术后24 h内使用镇痛药物补救人数、首次下床活动时间和不良反应的发生情况。结果 与ESPB组比较，TPVB组在拔管后30 min、术后2 h活动时的VAS评分更低，在切皮时、探查胆囊时MAP更低，芬太尼追加量更少(P<0.05)。两组芬太尼诱导量、芬太尼总量、镇痛药物补救人数、首次下床时间及术后不良反应差异无统计学意义。结论 TPVB和ESPB用于LC术后镇痛，均能取得满意的效果，TPVB更能减轻早期的疼痛，ESPB对循环干扰更小。更多还原

【Abstract】 Objective To compare the analgesic effects of thoracic paravertebral block and erector spinae plane block following laparoscopic cholecystectomy.Methods 80 patients, aged 18～64 years, with BMI 18.4～31.0 kg/m~2,and ASA grade Ⅰ～Ⅱ,scheduled for elective LC in our hospital from June 2023 to June 2024,were randomly divided into two groups: TPVB and ESPB groups, with 40 patients in each.Total 77 patients were included in the statistical analysis.Patients in both groups received TPVB or ESPB before anesthesia induction, at the T7 transverse process, with 20 ml of 0.5% ropivacaine injected on each side.VAS scores were recorded 30min after extubation, 2 h, 4 h, 8 h, 12 h, 24 h after operation, HR and MAP were recorded at the time of admission, skin incision, gallbladder operation and awakening, opioid consumption during operation, number of patients who used analgesic drugs within 24 h after operation, time of first ambulation and occurrence of adverse reactions were recorded.Results Compared with ESPB group, TPVB group had lower VAS scores at 30 minutes after extubation and 2 hours postoperatively during activity, lower MAP during skin incision and gallbladder exploration, and less fentanyl supplementation(P<0.05).There was no statistically significant difference between two groups in terms of fentanyl induction dose, total fentanyl dose, number of patients requiring rescue analgesics, time to first ambulation, and postoperative adverse events.Conclusion Both TPVB and ESPB achieve satisfactory analgesia following LC,with TPVB being more effective in relieving early postoperative pain and ESPB exerting less interference on the circulatory system.更多还原