目的 探讨罗哌卡因肋间神经阻滞对胸腔镜肺叶切除的术后镇痛效果。方法 选取2023年1月—2024年1月全麻下择期行胸腔镜肺叶切除术患者95例,采用随机数字表法分为试验组（47例,采用罗哌卡因肋间神经阻滞）和对照组（48例,采用竖脊肌平面阻滞）。比较两组患者手术不同时间点的生命体征[心率（HR）、平均动脉压（MAP）],术后48 h内静息、咳嗽状态下的疼痛评分[采用数字分级评分法（NRS）],术后恢复情况等。结果 阻滞前,两组患者HR、MAP组间比较,差异均无统计学意义（P>0.05）;在诱导插管后、切皮时以及拔管时,试验组MAP、HR均低于对照组（P<0.05）。试验组术后1、3、6、12 h静息和咳嗽状态下NRS评分均明显低于对照组（P<0.05）。试验组术后首次经口进食时间、排气时间、首次下床活动时间、术后住院天数均明显短于对照组（P<0.05）。结论 罗哌卡因肋间神经阻滞应用于胸腔镜肺叶切除手术患者,相比竖脊肌平面阻滞镇痛效果更好,且能帮助促进患者术后恢复。
Objective To investigate the postoperative analgesic effect of ropivacaine intercostal nerve block after thoracoscopic lobectomy. Methods A total of 95 patients who underwent thoracoscopic lobectomy under general anesthesia from January 2023 to January 2024 were selected. According to random number table method, 47 cases in the experimental group were treated with ropivacaine intercostal nerve block, and 48 cases in the control group were treated with erector spinae plane block. The two groups were compared in terms of intraoperative vital signs [heart rate （HR） and mean arterial pressure （MAP）] at selected time points, pain at rest and coughing within 48 h after surgery [by numerical rating scale （NRS）], and postoperative recovery. Results Before the block, there was no significant difference in HR and MAP between the two groups （P>0.05）. After induction of intubation, at skin incision, and extubation, the MAP and HR in the experimental group were lower than those in the control group （P<0.05）. The NRS scores at rest and coughing at 1, 3, 6, and 12 h after surgery in the experimental group were lower than those in the control group （P<0.05）. The time of first oral feeding, time of flatus, time of getting out of bed, and days of hospitalization after surgery in the experimental group were significantly shorter than those in the control group （P<0.05）. Conclusion Ropivacaine intercostal nerve block could yield better anagesic effect for patients undergoing thoracoscopic lobectomy than erector spinae plane block, and can facilitate postoperative recovery.
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