肋间神经阻滞镇痛在老年人小切口肺叶切除术后的临床观察

评价肋间神经阻滞镇痛在老年人小切口下开胸术后的临床效果。选取60例在胸腔镜辅助下小切口开胸的老年患者，随机分为三组，A、B组在关胸前以0．5％的ropivacain行肋间神经阻滞；B、C组术后均给予fentanyl（0．01mg／ml）静脉自控镇痛（PCIA）。结果直观模拟标度K（VAS）测定术后疼痛，三组患者均达到满意的效果，在血清皮质醇、血氧饱和度和不良反应方面A组与B组差异无显著（P〉O．05），C组与A、B组差并存在显著性（P〈O．05）。三组患者平均术后住院天数，A、B两组扣C组差异存在显著性（P〈O．05）。肋间神经阻滞镇痛对老年人小切口开胸手术减少术后疼痛和改善预后有较好的临床效果。

Effectiveness of Intercostal Nerve block Associated with Mini--thoracotomy on Postoperative Pain after Pulmonary Lobectomy of Elderly Patients

To evaluate the clinical effectiveness of intercostal nerve block （IINB） associated with mini--thoracotomy on postoperative pain and surgical outcome after pulmonary lobectomy of elderly patients. We selected 60 elderly patients undergoing mini--thoracotomy assisted by thoracoscope for pulmonary lobectomy, and randomly divided into three groups： group A and group B received IINB at the last moment of thoracotomy using 20 ml （5.0 mg/ml） ropivacain injection; groupB and group C using intravenous infusion of Fentanyl（0. 01mg/ml） postoperatively for 48h. Three groups have achieved satisfactory effectiveness by Visual analogue scale（VAS）, there were significant difference among group C and group A,group B at saturation of blood oxygen and serum cortisol, and adverse effects （P〈0.05）. Differences were significant in group C than group A and group B at mean postoperative hospital stay（P〈0.05）. IINB associated with minithoracotomy assisted by thoracoscope reduces postoperative pain and contributes to improve postoperative outcome after pulmonary lobectomy of elderly patients.