B超引导椎旁阻滞在肝癌手术中应用探究.doc

B超引导椎旁阻滞在肝癌手术中应用探究 　　[摘要] 目的 探?B超引导下椎旁神经阻滞在肝脏手术中的镇痛作用及其与传统硬膜外镇痛的差异。 方法 选取行剖腹肝癌切除术的患者60例，随机分成全麻复合硬膜外麻醉组（E组）和全麻复合椎旁阻滞组（P组），E组行硬膜外穿刺置管，P组在B超引导下行椎旁神经阻滞。术后E组采用硬膜外镇痛，P组采用静脉镇痛。对两组患者术中瑞芬太尼和麻黄碱用量，拔管后15 min（T0）、术后6 h（T1）、12 h（T2）、24 h（T3）、48 h（T4）的镇痛效果及术后并发症进行比较。 结果 E组术中麻黄碱用量较多[（2.17±3.64）mg，P0.05）。 结论 在肝脏手术中，椎旁阻滞联合术后静脉阿片类及非阿片类药物的多模式镇痛法，能达到不弱于硬膜外镇痛的术中及术后镇痛效果，且对血流动力学影响更小，术后不良反应更少 [关键词] B超引导；椎旁神经阻滞；硬膜外镇痛；多模式镇痛 [中图分类号] R614；R735.7 [文献标识码] B [文章编号] 1673-9701（2017）02-0104-04 Study on the application of B-ultrasound guided paravertebral block in liver cancer surgery ZHU Yuntian1 ZHANG Runze1 ZHOU Dachun2 FANG Jun1 1.Department of Anesthesiology， Zhejiang Cancer Hospital， Hangzhou 310022， China； 2.Department of Anesthesiology， Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine， Hangzhou 310016， China [Abstract] Objective To study the analgesic effect of B-ultrasound guided paravertebral nerve block in liver surgery and explore its difference from traditional epidural analgesia. Methods A total of 60 patients undergoing abdominal hepatectomy were selected in the study. They were randomly divided into general anesthesia combined with epidural anesthesia group（group E） and general anesthesia combined with paravertebral block group （group P）. Group E was given epidural catheter， and group P was given B-ultrasound guided paravertebral nerve block. Group E was given epidural analgesia and group P was given intravenous analgesia after the surgery. The dosage of remifentanil and ephedrine in the surgery， the analgesic effect 15 min（T0） after extubation， 6 h （T1）， 12 h （T2）， 24 h （T3）， and 48 h （T4） after surgery， and the postoperative complications were compared between the two groups. Results The dosage of ephedrine during the surgery was significantly higher in group E [（2.17±3.64） mg， P0.05）. Conclusion In the liver surgery， paravertebral nerve block combined with the multimodal analgesia of postoperative intravenous injection of opioid and no