超声引导下胸椎旁阻滞在多发肋骨骨折患者中的镇痛效果比较
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摘要
目的探讨在多发肋骨骨折患者中实施超声引导下胸椎旁阻滞的镇痛效果。方法选取2016年1月～2018年12月我院收治的多发肋骨骨折患者68例为研究对象,按随机数表法将患者分为静脉组和胸椎组,每组34例,静脉组实施舒芬太尼静脉自控镇痛,胸椎组实施超声引导下使用罗哌卡因胸椎旁阻滞,分析两种方式的镇痛效果、对患者血气的影响、肺功能的影响、镇痛安全性状况。结果胸椎组患者用药30 min后、用药1 d后、用药3 d后静息状态时VAS评分与静脉组比较,差异无统计学意义(P>0.05)。胸椎组患者用药30 min后、用药1 d后、用药3 d后咳嗽状态时VAS评分低于静脉组,差异有统计学意义(P<0.05)。胸椎组患者用药30 min后、用药3 d后动脉血氧分压及氧合指数高于静脉组,差异有统计学意义(P<0.05);胸椎组患者用药3 d后动脉二氧化碳分压与静脉组比较,差异无统计学意义(P>0.05)。胸椎组患者用药3 d后第1秒用力呼气量、用力肺活量高于静脉组,差异有统计学意义(P<0.05)。胸椎组患者恶心呕吐、嗜睡发生率显著低于静脉组,差异有统计学意义(P<0.05)。结论在多发肋骨骨折患者中实施超声引导下胸椎旁阻滞的镇痛效果良好,其在减轻患者咳嗽时疼痛方面优势较大,且可改善患者血气,促进肺功能恢复。
Objective To investigate the analgesic effect of ultrasound-guided thoracic paravertebral block in patients with multiple rib fractures. Methods A total of 68 patients with multiple rib fractures admitted in our hospital from January 2016 to December 2018 were enrolled. The patients were divided into the venous group and the thoracic vertebrae group according to the random number table, with 34 cases in each group. The venous group was implemented with Sufentanil intravenous self-controlled analgesia, and the thoracic vertebrae group was treated with ropivacaine thoracic paravertebral block under ultrasound guidance. The analgesic effect, blood gas impact, lung function, analgesic safety status of the two ways were analyzed. Results There was no significant difference in the VAS score between the thoracic vertebrae group and the venous group at 30 minutes, 1 day and 3 days after treatment(P>0.05). The VAS scores of the patients in the thoracic vertebrae group were lower than those in the venous group at 30 minutes, 1 day and 3 days after treatment, and the differences were statistically significant(P<0.05). At 30 minutes and 3 days after treatment,the arterial oxygen partial pressure and oxygenation index in the thoracic vertebrae group were higher than those in the venous group(P <0.05). There was no significant difference in arterial carbon dioxide partial pressure between the thoracic vertebrae group and the intravenous group at 3 days after treatment(P>0.05). In the thoracic vertebrae group, the forced expiratory volume and forced vital capacity in the first second were higher than those in the venous group at 3 days after treatment, and the differences were statistically significant(P<0.05). The incidence of nausea, vomiting and lethargy in the thoracic group was significantly lower than that in the venous group(P<0.05). Conclusion Ultrasoundguided thoracic paravertebral block in patients with multiple rib fractures has a good analgesic effect. It has a great advantage in relieving pain in patients with cough, and can improve blood gas and promote lung function recovery.
Objective To investigate the analgesic effect of ultrasound-guided thoracic paravertebral block in patients with multiple rib fractures. Methods A total of 68 patients with multiple rib fractures admitted in our hospital from January 2016 to December 2018 were enrolled. The patients were divided into the venous group and the thoracic vertebrae group according to the random number table, with 34 cases in each group. The venous group was implemented with Sufentanil intravenous self-controlled analgesia, and the thoracic vertebrae group was treated with ropivacaine thoracic paravertebral block under ultrasound guidance. The analgesic effect, blood gas impact, lung function, analgesic safety status of the two ways were analyzed. Results There was no significant difference in the VAS score between the thoracic vertebrae group and the venous group at 30 minutes, 1 day and 3 days after treatment(P>0.05). The VAS scores of the patients in the thoracic vertebrae group were lower than those in the venous group at 30 minutes, 1 day and 3 days after treatment, and the differences were statistically significant(P<0.05). At 30 minutes and 3 days after treatment,the arterial oxygen partial pressure and oxygenation index in the thoracic vertebrae group were higher than those in the venous group(P <0.05). There was no significant difference in arterial carbon dioxide partial pressure between the thoracic vertebrae group and the intravenous group at 3 days after treatment(P>0.05). In the thoracic vertebrae group, the forced expiratory volume and forced vital capacity in the first second were higher than those in the venous group at 3 days after treatment, and the differences were statistically significant(P<0.05). The incidence of nausea, vomiting and lethargy in the thoracic group was significantly lower than that in the venous group(P<0.05). Conclusion Ultrasoundguided thoracic paravertebral block in patients with multiple rib fractures has a good analgesic effect. It has a great advantage in relieving pain in patients with cough, and can improve blood gas and promote lung function recovery.
引文
[1]欧晓峰,华玉思,郑瑞强,等.肋间神经阻滞在ICU肋骨骨折患者中应用的临床研究[J].中华急诊医学杂志,2016,25(6):840-842.
[2]张瑛,陈军,王爱忠,等.超声引导胸椎旁神经阻滞对于肋骨骨折患者术后镇痛效果的影响[J].创伤外科杂志,2016,18(10):591-594.
[3]卢浩杰.超声引导胸椎旁神经阻滞对于肋骨骨折患者术后镇痛效果的影响分析[J].中外医学研究,2017,15(28):14-15.
[4]张振伟,范晓艳,张云华,等.持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用[J].山东大学学报(医学版),2016,54(6):39-42.
[5]邓佳,许婷,蔡兵,等.超声引导胸椎旁阻滞对胸部创伤急性疼痛的疗效[J].甘肃医药,2016,35(1):42-44.
[6]赵淑芳,黄中梅,张磊,等.超声引导下肋间神经阻滞复合静脉镇痛用于肋骨骨折切开复位内固定手术术后镇痛[J].实用疼痛学杂志,2017,13(5):365-367.
[7]王颖,冯娟.不同镇痛方式在多发肋骨骨折患者疼痛管理中的应用[J].世界临床医学,2016,10(21):26.
[8]罗振国,邵冠一,易双强,等.罗哌卡因局部浸润联合地佐辛肌肉注射对多发肋骨骨折患者术后镇痛的影响[J].陕西医学杂志,2017,46(10):1463-1464,1476.
[9]韩书勤,徐家济.氟比洛芬酯复合舒芬太尼在肋骨骨折患者术后镇痛中的应用[J].基层医学论坛,2016,20(2):175-176.
[10]葛叶盈,王秀珍,袁娜,等.超声引导自控胸椎旁神经阻滞对多发肋骨骨折患者肺功能的影响[J].中华外科杂志,2016,54(12):924-928.
[11]吴亚谋,王霆.超声引导下臂丛神经阻滞联合胸椎旁阻滞用于肱骨近端骨折手术的效果观察[J].锦州医科大学学报,2017,38(5):70-72.
[12]洪波.超声引导下臂丛联合胸椎旁阻滞对肩胛骨骨折内固定患者术后镇痛效果的影响[J].中国现代医生,2018,56(26):107-110.
[13]何少奇,夏海杰,汤呈宣,等.超声引导下胸椎旁神经阻滞在经皮椎体后凸成形术中的应用[J].中华全科医师杂志,2018,17(8):634-636.
[14]杨永刚,严海.超声引导下臂丛联合胸椎旁阻滞对肩胛骨骨折内固定患者术后镇痛效果的影响[J].临床麻醉学杂志,2017,33(10):977-979.
[15]周嘉莉,祝胜美,夏燕飞,等.超声引导下胸椎旁神经阻滞在开胸手术中的效果[J].中国乡村医药,2016,23(1):13-15.
[2]张瑛,陈军,王爱忠,等.超声引导胸椎旁神经阻滞对于肋骨骨折患者术后镇痛效果的影响[J].创伤外科杂志,2016,18(10):591-594.
[3]卢浩杰.超声引导胸椎旁神经阻滞对于肋骨骨折患者术后镇痛效果的影响分析[J].中外医学研究,2017,15(28):14-15.
[4]张振伟,范晓艳,张云华,等.持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用[J].山东大学学报(医学版),2016,54(6):39-42.
[5]邓佳,许婷,蔡兵,等.超声引导胸椎旁阻滞对胸部创伤急性疼痛的疗效[J].甘肃医药,2016,35(1):42-44.
[6]赵淑芳,黄中梅,张磊,等.超声引导下肋间神经阻滞复合静脉镇痛用于肋骨骨折切开复位内固定手术术后镇痛[J].实用疼痛学杂志,2017,13(5):365-367.
[7]王颖,冯娟.不同镇痛方式在多发肋骨骨折患者疼痛管理中的应用[J].世界临床医学,2016,10(21):26.
[8]罗振国,邵冠一,易双强,等.罗哌卡因局部浸润联合地佐辛肌肉注射对多发肋骨骨折患者术后镇痛的影响[J].陕西医学杂志,2017,46(10):1463-1464,1476.
[9]韩书勤,徐家济.氟比洛芬酯复合舒芬太尼在肋骨骨折患者术后镇痛中的应用[J].基层医学论坛,2016,20(2):175-176.
[10]葛叶盈,王秀珍,袁娜,等.超声引导自控胸椎旁神经阻滞对多发肋骨骨折患者肺功能的影响[J].中华外科杂志,2016,54(12):924-928.
[11]吴亚谋,王霆.超声引导下臂丛神经阻滞联合胸椎旁阻滞用于肱骨近端骨折手术的效果观察[J].锦州医科大学学报,2017,38(5):70-72.
[12]洪波.超声引导下臂丛联合胸椎旁阻滞对肩胛骨骨折内固定患者术后镇痛效果的影响[J].中国现代医生,2018,56(26):107-110.
[13]何少奇,夏海杰,汤呈宣,等.超声引导下胸椎旁神经阻滞在经皮椎体后凸成形术中的应用[J].中华全科医师杂志,2018,17(8):634-636.
[14]杨永刚,严海.超声引导下臂丛联合胸椎旁阻滞对肩胛骨骨折内固定患者术后镇痛效果的影响[J].临床麻醉学杂志,2017,33(10):977-979.
[15]周嘉莉,祝胜美,夏燕飞,等.超声引导下胸椎旁神经阻滞在开胸手术中的效果[J].中国乡村医药,2016,23(1):13-15.