本文選題：胸外科手術(shù)　切入點(diǎn)：麻醉　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年01期 　論文類型：期刊論文

【摘要】：目的:評估在超聲引導(dǎo)下采用平面內(nèi)方法,經(jīng)外側(cè)肋間入路行胸椎旁阻滯技術(shù)的可行性和成功率。方法:選取27例擇期行胸外科手術(shù)的患者,于術(shù)前進(jìn)行胸椎旁阻滯。超聲探頭置于脊柱旁8 cm左右,平行肋骨長軸在第5肋間隙進(jìn)行掃描,以肋間內(nèi)肌和肋間最內(nèi)肌之間的間隙作為穿刺目標(biāo)進(jìn)針,穿刺針到達(dá)目標(biāo)區(qū)域后,推注0.5%(質(zhì)量分?jǐn)?shù))羅哌卡因20 m L后置管,在超聲下評估導(dǎo)管頭端位置是否良好,記錄給藥后10、20、30 min冷觸覺阻滯平面。術(shù)后連接鎮(zhèn)痛泵經(jīng)導(dǎo)管持續(xù)泵注0.2%羅哌卡因6 m L/h進(jìn)行鎮(zhèn)痛,記錄術(shù)后1、6、24、48 h冷觸覺阻滯平面及疼痛程度評分。結(jié)果:1次置管成功率81.48%(22/27),另5例患者分別在第2次置管和第3次置管后成功。給予負(fù)荷劑量給藥后10、20、30 min冷觸覺阻滯平面數(shù)中位數(shù)分別為2、3、4,術(shù)后1、6、24、48 h冷觸覺阻滯平面數(shù)及疼痛程度評分中位數(shù)分別為5、5、5、4以及1、1、2、2,無患者發(fā)生雙側(cè)阻滯、氣胸及誤穿血管等并發(fā)癥。結(jié)論:采用上述外側(cè)肋間入路技術(shù)進(jìn)行胸椎旁阻滯具有良好的可行性,阻滯成功率高,并發(fā)癥少。
[Abstract]:Objective: to evaluate the feasibility and success rate of thoracic paravertebral block via lateral intercostal approach under ultrasound guidance. Thoracic paravertebral block was performed before operation. The ultrasonic probe was placed about 8 cm beside the spine, parallel rib long axis was scanned in the fifth costal space, and the space between intercostal and intercostal innermost muscles was used as the puncture target. After the puncture needle reached the target area, 0.5% ropivacaine (mass fraction) was injected with 20 mL posterior tube to evaluate the good position of the catheter head under ultrasound. The cold tactile block level was recorded at 10: 20 and 30 min after administration. Postoperative analgesic pump was continuously injected with 0.2% ropivacaine for 6 mL / h. The scores of cold tactile block level and pain degree were recorded at 1: 6 and 24 / 48 hours postoperatively. Results the success rate of 1: 1 catheterization was 81.48 ~ 22 / 27, and the other 5 patients were successfully placed at the second and third times respectively. Cold tactile block was performed at 10 ~ 20 ~ 30 min after administration of loading dose. The median of plane number was 2 / 3 / 4, and the median of cold tactile block level and pain score were 5 / 5, 5 / 4 and 1 / 1 / 2 / 2, respectively. No bilateral block was found in the patients with cold tactile block at 1: 6 and 24 / 48 h postoperatively. The median score of cold tactile block and pain degree were 5, 5, 5 and 2, respectively. Conclusion: the technique of lateral intercostal approach is feasible for thoracic paravertebral block with high success rate and few complications.
【作者單位】： 北京大學(xué)第三醫(yī)院麻醉科;北京大學(xué)第三醫(yī)院胸外科;
【分類號(hào)】：R614

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