【作者】 赵敏；

【导师】 张建文；

【作者基本信息】 山西医科大学 ， 麻醉学（专业学位）， 2024， 硕士

【摘要】 目的:探讨超声引导下的单次胸椎旁神经阻滞和竖脊肌平面阻滞对接受胸腔镜肺叶切除手术患者胃肠功能和术后恢复质量的影响。为外周神经阻滞技术应用于胸腔镜手术促进快速康复提供思路和临床研究资料。方法:招募90例接受择期全身麻醉下的胸腔镜肺叶切除手术的患者,所有患者均进行静脉麻醉诱导,根据是否联合神经阻滞将患者随机分为3组:全身麻醉组(G组)、全身麻醉联合胸椎旁神经阻滞组(GT组)和全身麻醉联合竖脊肌平面阻滞组(GE组)。G组患者不进行外周神经阻滞,GT组患者于患侧T5-T6胸椎旁间隙注入0.5%罗哌卡因30ml,GE组患者在竖脊肌深面与T5和T6横突间隙注入0.5%罗哌卡因共30ml。主要观察指标:术后腹胀发生率。次要观察指标:首次排气排便时间、肠鸣音恢复、恶心呕吐发生率、患者术后Qo R-15量表评分及VAS疼痛评分,围术期舒芬太尼消耗量及住院时间。结果:与G组相比,GT组和GE组患者术后腹胀发生率降低(P<0.05),术后首次排气排便时间缩短(P<0.05),肠鸣音恢复加快(P<0.05),术后恶心呕吐发生率降低(P<0.05),术后12h、24h和48h Qo R-15量表评分均升高(P<0.05),术后1h、6h和12h VAS疼痛评分均降低(P<0.05),围术期舒芬太尼消耗量减少(P<0.05),住院时间显著缩短(P<0.05)。各观察指标在GT组和GE组比较差异均无统计学意义(P>0.05)。结论:超声引导下单次胸椎旁神经阻滞和竖脊肌平面阻滞均可为胸腔镜肺叶切除患者提供有效的胃肠功能保护,增强镇痛效果,改善恢复质量,缩短住院时间,促进快速康复。更多还原

【Abstract】 Objective:To explore the effects of ultrasound guided single thoracic paravertebral nerve block and erector spinae plane block on gastrointestinal function and recovery quality in patients undergoing thoracoscopic lobectomy,and to provide ideas and clinical research data for the application of peripheral nerve block technology in thoracoscopic surgery to promote rapid recovery.Methods:A total of 90 patients undergoing thoracoscopic lobectomy under elective general anesthesia were included.All patients were induced with intravenous anesthesia,and the patients were randomly divided into 3 groups based on whether to combine nerve block:general anesthesia group(group G),general anesthesia combined with thoracic paravertebral nerve block(group GT)and general anesthesia combined with erector spinae plane block group(group GE).In the group GT,30 ml of 0.5% ropivacaine was injected into the paravertebral space on the affected side at the T5-T6 thoracic vertebrae,while in the group GE,a total of 30 ml of 0.5% ropivacaine was injected into the deep surface of the erector spinae and the gap between the transverse processes of T5 and T6.,and the patients in the group G did not undergo peripheral nerve block.The primary outcome measures include the incidence of postoperative abdominal distension.Secondary outcome measures include the time to first defecation,recovery of bowel sounds,and incidence of nausea and vomiting,the postoperative Qo R-15 scores and VAS pain scores,perioperative sufentanil dosage,and length of hospitalization time.Results:Compared to group G,the GT and GE groups showed a reduction in the incidence of postoperative abdominal distension(P<0.05),a shortening of the time to first postoperative defecation(P<0.05),an acceleration in the recovery of bowel sounds(P<0.05),and a reduction in the incidence of postoperative nausea and vomiting(P<0.05).The Qo R-15 scale scores were higher at 12,24 and 48 hours after surgery(P<0.05),and the VAS pain scores were lower at 1,6 and 12 hours after surgery(P<0.05).The amount of sufentanil used during the perioperative period was significantly reduced(P<0.05),and the hospitalization time was significantly shortened(P<0.05).No significant disparities were observed between the GT group and the GE group in any of the observed indicators(P>0.05).Conclusion:Ultrasound-guided single thoracic paravertebral nerve block and erector spinae plane block could effectively protect gastrointestinal function,enhance analgesic effects,improve recovery quality,shorten hospitalization time,and promote rapid recovery for patients undergoing thoracoscopic lobectomy.更多还原