首页|肋间神经阻滞+鞘内注射吗啡对电视辅助胸腔镜手术患者的影响

肋间神经阻滞+鞘内注射吗啡对电视辅助胸腔镜手术患者的影响

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目的:评价肋间神经阻滞+鞘内注射吗啡对电视辅助胸腔镜手术(VATS)患者的影响。方法:选取 2022 年 3-11 月扬州大学附属医院收治的 90 例VATS患者。根据随机数法将其分为肋间神经阻滞组(L组)、肋间神经阻滞+鞘内注射吗啡组(LQ组)和对照组(C组),各 30 例。LQ组给予肋间神经阻滞+鞘内注射吗啡,L组给予肋间神经阻滞,C组不做处理。比较三组围手术期指标,相关指标,清醒后30 min(T0)、术后4 h(T1)、术后8 h(T2)、术后12 h(T3)、术后 18 h(T4)、术后 24 h(T5)、术后 48 h(T6)的疼痛程度及不良反应。结果:三组手术时间、单肺通气时间比较,差异无统计学意义(P>0。05)。T1~6,LQ组静息及运动疼痛数字评分法(NRS)评分显著低于C组;T2~6,LQ组静息和运动NRS评分均低于L组,差异有统计学意义(P<0。05)。LQ组术后患者自控静脉镇痛(PCIA)有效按压次数及补救镇痛率显著低于L组及C组,差异有统计学意义(P<0。05)。三组不良反应发生率比较,差异无统计学意义(P>0。05)。结论:鞘内吗啡镇痛可为胸腔镜下肺叶切除患者单次肋间神经阻滞提供良好的桥接镇痛效果,减少阿片类药物使用,利于患者恢复。
Effect of Intercostal Nerve Block+Intravaginal Morphine Injection on Patients Undergoing Video-assisted Thoracoscopic Surgery
Objective:To evaluate the effect of intercostal nerve block+intravaginal Morphine injection on patients undergoing video-assisted thoracoscopic surgery(VATS).Method:A total of 90 VATS patients admitted to Affiliated Hospital of Yangzhou University from March to November 2022 were selected.According to random number method,the patients were divided into intercostal nerve block group(L group),intercostal nerve block+intravaginal Morphine injection group(LQ group)and control group(C group),with 30 cases in each group.LQ group was given intercostal nerve block+intrathecal Morphine injection,L group was given intercostal nerve block,C group was not treated.Perioperative indexes,related indexes,pain degree at 30 min after wakefulness(T0),4 h after surgery(T1),8 h after surgery(T2),12 h after surgery(T3),18 h after surgery(T4),24 h after surgery(T5),48 h after surgery(T6)and adverse reactions were compared among the three groups.Result:There was no significant difference in operation time and single lung ventilation time among the three groups(P>0.05).From T1~6,the resting and exercise numerical rating scale(NRS)scores of LQ group were significantly lower than those of C group,the resting and exercise NRS scores of the LQ group were lower than those of the L group from T2~6,and the differences were statistically significant(P<0.05).The effective pressing times of patient controlled intravenous analgesia(PCIA)and the rate of remedial analgesia in LQ group were significantly lower than those in L group and C group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:Intravaginal Morphine analgesia can provide good bridging analgesia for single intercostal nerve block in patients with thoracoscopic below lobectomy,reduce the use of opioids,and facilitate patient recovery.

Intrathecal injectionIntercostal nerve blockVideo assisted thoracoscopic surgeryAnalgesia Morphine

黄雯、孙鲁瑜、张建友、唐苏红

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扬州大学附属医院 江苏 扬州 225000

扬州大学医学院

大连医科大学研究生院

鞘内注射 肋间神经阻滞 电视辅助胸腔镜手术 镇痛 吗啡

扬州市社会发展项目

YZ2022109

2024

中外医学研究
中国医院管理杂志社

中外医学研究

影响因子:1.149
ISSN:1674-6805
年,卷(期):2024.22(13)
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