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超声下肋间神经阻滞联合静脉镇痛及护理在腔镜肺癌根治术中的应用

Application of ultrasound-guided intercostal nerve block combined with intravenous analgesia and nursing for lung cancer patients with thoracoscopic radical surgery

    摘要
  • 摘要:
      目的  观察超声引导下肋间神经阻滞联合静脉镇痛对胸腔镜肺癌根治术后患者的临床效果以及系统性整体护理的干预效果。
      方法  选取60例胸腔镜肺癌根治术患者作为研究对象，按照术后镇痛方法的不同分为观察组与对照组，每组30例。观察组接受超声引导下肋间神经阻滞联合静脉镇痛，对照组接受硬膜外镇痛，2组均接受系统化整体护理干预。比较2组患者术后2、4、6、12、24、48 h的镇痛评分、Ramsay镇静评分，并比较2组患者护理前后的护士用住院患者观察量表（NOSIE）评分和术后不良反应发生情况。
      结果  观察组术后2、4、6、12 h的活动痛、静息痛评分均低于对照组，差异有统计学意义（P < 0.05）；观察组术后24、48 h的活动痛、静息痛评分均高于对照组，差异有统计学意义（P < 0.05）。观察组术后2、4、6、12、24、48 h的Ramsay镇静评分均高于对照组，差异有统计学意义（P < 0.05）。护理后，2组NOSIE评分均低于护理前，但观察组NOSIE评分高于对照组，差异有统计学意义（P < 0.05）。观察组术后不良反应发生率高于对照组，差异有统计学意义（P < 0.05）。
      结论  与硬膜外镇痛相比，超声引导下肋间神经阻滞联合静脉镇痛对胸腔镜肺癌根治术后患者的前期镇痛效果更好，但镇痛作用持续时间较短，且存在过度镇静、不良反应发生率高的问题，更需进行系统性整体护理干预。

     

    Abstract:
      Objective  To observe clinical efficacy of ultrasound-guided intercostal nerve block combined with intravenous analgesia for lung cancer patients with thoracoscopic radical surgery and nursing effect of systemic holistic care.
      Methods  A total of 60 patients with lung cancer undergoing thoracoscopic radical operation were selected as study objects, and were divided into observation group and control group according to different postoperative analgesia methods, with 30 cases in each group. The observation group was given ultrasound-guided intercostal nerve block combined with intravenous analgesia, while the control group was given epidural analgesia. The analgesic scores at 2, 4, 6, 12, 24 and 48 h after operation and Ramsay scores were compared between the two groups. Postoperative adverse reactions and scores of Nurses' Observation Scale for Inpatient Evaluation (NOSIE) were compared before and after nursing.
      Results  The scores of active pain and resting pain in the observation group at 2, 4, 6 and 12 h were significantly lower than those in the control group (P < 0.05), but the scores of active pain and resting pain in the observation group at 24 and 48 h after operation were significantly higher than the control group (P < 0.05); the Ramsay scores at 2, 4, 6, 12, 24 and 48 h of the observation group were significantly higher than those of the control group (P < 0.05). After nursing, NOSIE scores of the two groups were lower than before nursing, but the observation group was higher than the control group (P < 0.05). The incidence of postoperative adverse reactions in the observation group was significantly higher than that in the control group (P < 0.05).
      Conclusion  Ultrasound-guided intercostal nerve block combined with intravenous analgesia has better efficacy than epidural analgesia, but its duration of intercostal nerve block analgesia is short, and there are excessive sedation and high incidence of adverse reactions. Therefore, these patients need to conduct systematic holistic nursing intervention.

     

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