胸段硬膜外阻滞与胸椎旁阻滞对开胸肺叶手术后镇痛效果及肺功能的影响

目的 探讨胸段硬膜外阻滞与胸椎旁阻滞对开胸肺叶手术后镇痛效果及肺功能的影响.方法 收取行开胸肺叶手术的肺癌患者75例作为研究对象,随机分为A、B两组,A组37例患者术后采用胸段硬膜外阻滞,B组38例患者术后采用胸椎旁阻滞.对比两组患者T0(入室时)、T1(切皮时)以及T2(缝皮时)时生命体征,手术后6 h、12 h、24 h以及48 h时疼痛镇静评分、肺功能以及并发症发生情况.结果 T1时A组患者平均动脉压(MAP)及心率(HR)明显高于T0时及B组T1时,差异具有统计学意义(P<0.05).两组患者术后VAS疼痛评分及Ramsay镇静评分比较均无显著差异(P>0.05).两组患者术后用力肺活量(FVC)、第一秒用力呼气容积(FEV1)及呼气中期流速(MMEF75/25)均较术前明显下降,且A组患者FVC及FEV1较同时间点B组下降更加明显,差异有统计学意义(P<0.05).A组患者并发症发生率为27.03%,远高于B组并发症发生率(7.89%),差异具有统计学意义(P<0.05).结论 胸椎旁阻滞与胸段硬膜外阻滞镇痛效果相当,但对患者肺功能早期恢复具有积极的意义,可减少并发症发生,值得临床开展应用.

Analgesic Effect and Influence on Lung Function of TEB and TPVB in an Open Pulmonary Lobectomy

Objective To explore the analgesic effect and influence on lung function of thoracic epidural block and ( TEB) and thoracic paravertebral block ( TPVB) in an open pulmonary lobectomy .Methods 75 patients with lung cancer un-derwent open pulmonary lobectomy were selected and randomly divided into group A and group B .37 patients in group A under-went TEB,and 38 patients in group B underwent TPVB.The vital signs in T0(pre-operating)、T1(skin incision) and T2(surgical sutures),the VAS scores and Ramsay scores and lung fuction 6 h,12 h,24 h and 48 h after surgery and complications of the 2 groups were compared.Results MAP and HR of group A in T1 were obviously higher than T0 and group B in T1 with statistically significance(P<0.05).The VAS scores and Ramsay scores of 2 groups after surgery had no statistically differences (P>005). The FVC,FEV1 and MMEF75/25 of 2 groups after surgery were all lower than before ,and group A had a greater decline ( P<0.05).The complication rate of group A was 27.03%,which was obviously higher than 7.89%of group B with statistically sig-nificance(P<0.05).Conclusion TPVB has a good analgesic effect compared to TEB ,but has positive significance in the early stage recovery of lung fuction and complication rate inducing ,it is worthy of clinical applictaions .