持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用

doi:10.6040/j.issn.1671-7554.0.2016.313

山东大学学报（医学版） ›› 2016, Vol. 54 ›› Issue (6): 39-42.doi: 10.6040/j.issn.1671-7554.0.2016.313

持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用

张振伟¹,范晓艳²,张云华¹,蒋仲敏³

1.济南市第三人民医院胸外科, 山东济南 250132;2.山东省中医药大学附属医院心内科, 山东济南 250062;3.山东大学附属千佛山医院胸外科, 山东济南 250014

收稿日期:2016-03-22 出版日期:2016-06-20 发布日期:2016-06-20
通讯作者: 蒋仲敏. E-mail:qyjzm@sina.com E-mail:qyjzm@sina.com

Analgesic effect of continuous thoracic paravertebral block in patients with multiple fractured ribs

ZHANG Zhenwei¹, FAN Xiaoyan², ZHANG Yunhua¹, JIANG Zhongmin³

1. Department of Chest Surgery, Third Hospital to Jinan, Jinan 250132, Shandong, China;
2. Department of Cardiology, Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan 250014, Shandong, China;
3. Department of Chest Surgery, Qianfoshan Hospital Affilicated to Shandong University, Jinan 250014, Shandong, China

Received:2016-03-22 Online:2016-06-20 Published:2016-06-20

摘要/Abstract

摘要： 目的观察持续胸椎旁神经阻滞用于多发肋骨骨折镇痛的临床效果。方法选择多发肋骨骨折患者92例,按照胸椎旁神经阻滞给予罗哌卡因持续泵入镇痛(TPVB组)和根据疼痛程度间断给予吗啡镇痛(MOP组)两种治疗方案进行回顾分析,每组46例。观察指标:TPVB组置管前后疼痛评分(VAS)和呼吸频率(RR),TPVB组和MOP组在置管后12、24 h动脉血氧分压、二氧化碳分压及伤后5 d胸腔积液量。结果 TPVB组置管后VAS评分明显降低,呼吸频率明显减低(P<0.05),TPVB组12、24 h动脉血氧分压明显高于MOP组,二氧化碳分压明显低于MOP组,差异均有统计学意义(P<0.05),TPVB组伤后5 d胸腔积液量较MOP组明显减少(P<0.05)。结论持续胸椎旁神经阻滞对多发肋骨骨折镇痛效果较好,有效促进肺功能恢复,减少肺不张的形成。

关键词: 胸椎旁神经阻滞, 疼痛控制, 肋骨骨折, 罗哌卡因

Abstract: Objective To observe the analgesic effect of continuous thoracic paravertebral block in patients with multiple fractured ribs. Methods A total of 92 patients with unilateral fractured ribs were randomly divided into 2 groups: TPVB group(n=46, received continuous ropivacaine infusion through thoracic paravertebral block)and MOP group(n=46, received various dosages of morphine). Visual analog scale scores(VAS)at rest and on coughing, and respiratory rate were measured before and after administration of the block. The postoperative 12-hour and 24-hour oxygen partial pressure(PO₂)and partial pressure of carbon dioxide(PCO₂), and 5-day post-injury pleural effusion quantity were detected. Results After administration of block, the mean VAS and respiratory rate decreased significantly(P<0.05). The average PO₂ in the TPVB group were higher than that in the MOP group(P<0.05), while the average PCO₂ were significantly lower in the TPVB group than that in the MOP group(P<0.05). The 5-day post-injury pleural effusion quantity of TPVB group was less than that of MOP group(P<0.05). Conclusion Continuous thoracic paravertebral block significantly improves pulmonary function and relieves pain, and shortens pulmonary atelectasis in patients with multiple fractured ribs.

Key words: Rib fractures, Ropivacaine, Thoracic paravertebral block, Pain control

中图分类号:

R683.1

张振伟,范晓艳,张云华,蒋仲敏. 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.

ZHANG Zhenwei, FAN Xiaoyan, ZHANG Yunhua, JIANG Zhongmin. Analgesic effect of continuous thoracic paravertebral block in patients with multiple fractured ribs[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(6): 39-42.

参考文献

[1] Bulger EM, Arneson MA, Mock CN, et al. Rib fractures in the elderly[J]. J Trauma, 2000, 48(6): 1040-1047.
[2] Karmakar MK, Critchley LA, Ho AM, et al. Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs[J]. Chest, 2003, 123(2): 424-431.
[3] Carrier FM, Turgeon AF, Nicole PC, et al. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and metaanalysis of randomized controlled trials[J]. Can J Anaesth, 2009, 56(3): 230-242.
[4] Kieninger AN, Bair HA, Bendick PJ, et al. Epidural versus intravenous pain control in elderly patients with rib fractures[J]. Am J Surg, 2005, 189(3): 327-330.
[5] Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the break point for mortality[J]. Surgery, 2005, 138(4): 717-723.
[6] Ho AM, Karmakar MK, Critchley LA, et al. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques[J]. Curr Opin Crit Care, 2011, 17(4): 323-327.
[7] Schnabel A, Reichl SU, Kranke P, et al. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials[J]. Br J Anaesth, 2010, 105(6): 842-852.
[8] 孙立新,丛丽,王明山,等.双侧胸椎旁神经阻滞术后镇痛在非体外循环冠脉搭桥术患者中的应用[J].中华医学杂志,2013, 93(45):3569-3572. SUN Lixin, CONG Li, WANG Mingshan, et al. Feasibility study of bilateral thoracic paravertebral block for postoperative analgesia in patients after off-pump coronary artery bypass grafting[J]. Natl Med J China, 2013, 93(45): 3569-3572.
[9] Okajima H, Tanaka O, Ushio M, et al. Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery[J]. J Anesth, 2015, 29(3): 373-378.
[10] 高俊刚, 白璐, 金晨望, 等. 基于CT图像对游离胸腔积液简易定量方法[J]. 中国医学影像技术, 2015, 31(2): 169-172.
[11] Taylor R, Massey S, Stuart Smith K. Postoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade[J]. J Cardiothorac Vasc Anesth, 2004, 18(3): 317-321.
[12] Shanti CM, Carlin AM, Tyburski JG, et al. Incidence of pneumothorax from intercostal nerve blocks for analgesia in rib fractures[J]. J Trauma, 2001, 51(3): 536-539.
[13] Simon BJ, Cushman J, Barraco R, et al. Pain management guidelines for blunt thoracic trauma[J]. J Trauma, 2005, 59(5): 1256-1267.
[14] Naja MZ, Ziade MF, Lönnqvist PA. General anaesthesia combined with bilateral paravertebral blockade(T 5-6)vs. general anaesthesia for laparoscopic cholecystectomy: a prospective, randomised clinical trial[J]. Eur J Anaesthesiol, 2004, 21(6): 489-495.
[15] Mohta M, Verma P, Saxena AK, et al. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs-a pilot study[J]. J Trauma, 2009, 66(4): 1096-1101.
[16] Ho AM, Karmakar MK, Critchley LAH. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques[J]. Curr Opin Crit Care, 2011, 17(4): 323-327.
[17] Liu Z, Gao F, Tian Y. Effects of morphine, fentanyl, and toradol on human immune response[J]. J Huazhong Univ Sci Echnolog Med Sci, 2006, 26(4): 478-481.
[18] Ozyuvaci E, Akyol O, Sitilci T, et al. Preoperative ultra-sound-guided suprascapular nerve block for post-thoracotomy shoulder pain[J]. Ann Surg, 2013, 238(5): 663-673.

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持续胸椎旁神经阻滞在多发肋骨骨折镇痛方面的应用

Analgesic effect of continuous thoracic paravertebral block in patients with multiple fractured ribs

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