Objective: To investigate the effects of ultrasound-guided lateral and medial point blocks of thoracic paravertebral space on the rapid recovery of laparoscopic cholecystectomy. Methods: A total of 90 patients of either sex, aged 18-67 years, weighted 45.10-91.80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparoscopic cholecystectomy were divided into two groups (n=45) using a random number table: lateral point group of thoracic paravertebral space (group A) and medial point group of thoracic paravertebral space (group B). Ultrasound-guided thoracic paravertebral nerve block was performed before induction of general anesthesia. The puncture point of group A was positioned as the intercostal block of the thoracic paravertebral space of the right side of T(6)-T(11), and the puncture point of the group B was positioned as the thoracic paravertebral body of the right side of T(6)-T(11) thoracic paravertebral space. The thoracic paravertebral block was performed with 2 ml of 0.75% ropivacaine per injection for a total of 10 ml. The visual analog scale (VAS) scores of resting pain and active pain at 4, 8, 12 and 24 h after operation were observed. The anus recovery time after surgery and perioperative hypotension were also recorded. Results: The blood pressures in group A were significantly higher than those in group B at 4, 8, 12 and 24 h after operation, which were(73±7) vs (70±7), (78±7) vs (74±7),(82±7) vs (79±7),and (87±7) vs (83±7) mmHg,and the differences were statistically significant (t=2.29, 2.54, 2.33, 2.37, all P<0.05). The VAS scores of resting pain and active pain in group A were significantly higher than those in group B, and the differences were statistically significant (Z=-2.29, -2.51, -2.21, -2.39, -2.53, -2.25, -2.30, -2.24, all P<0.05). The postoperative anal exhaust recovery time of the patients in group A was (21.8±1.9) min that was obvious lower than that in group B which was (22.7±1.9) min with statistically significant difference (t=2.12, P<0.05). There was no significant difference in the incidence of postoperative dizziness, nausea, vomiting, and pruritus (χ(2)=0.28, 0.72, 0.45, 0.21,all P>0.05). Conclusions: In the procedure of thoracic paravertebral block under the guidance of ultrasound, the closer blocking points are to the central axis of the spine, the better the postoperative analgesic effect, but the more obvious the postoperative blood pressure reduction and the longer the anal recovery exhaust time. The further away from the central axis of the spine, the more analgesic effect decreases, but the blood pressure decreases and the anal recovery time is relatively rapid.
目的： 探讨超声引导胸椎旁间隙外侧点和内侧点阻滞对腹腔镜胆囊切除术后快速康复疗效的影响。 方法： 选取嘉兴市第一医院2017年9月至2018年8月择期行腹腔镜胆囊切除手术患者90例，性别不限，年龄18~67岁，体重45.10~91.80 kg，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n=45）：胸椎旁间隙外侧点组（A组），胸椎旁间隙内侧点组（B组）。全麻诱导前均行超声引导下胸椎旁神经阻滞。A组患者穿刺点选择为右侧T(6)~T(11)胸椎旁间隙肋间内肌阻滞点，B组患者穿刺点选择为右侧T(6)~T(11)胸椎旁间隙胸椎体旁阻滞点，用药均为0.75%罗哌卡因每点注射2 ml，总量10 ml。观察两组患者在术后4、8、12、24 h时静息痛和活动痛的视觉模拟量表（VAS）评分；同时记录患者手术后肛门恢复排气时间以及围手术期低血压等发生情况。 结果： 术后4、8、12、24 h A组患者血压分别为（73±7）、（78±7）、（82±7）、（87±7）mmHg，显著高于B组的（70±7）、（74±7）、（79±7）、（83±7）mmHg，差异均有统计学意义（t=2.29、2.54、2.33、2.37，均P<0.05）；A组静息痛和活动痛VAS评分均显著高于B组，差异均有统计学意义（Z=-2.29、-2.51、-2.21、-2.39；－2.53、-2.25、-2.30、-2.24，均P<0.05）；A组患者术后肛门恢复排气时间为（21.8±1.9）min，小于B组的（22.7±1.9）min，差异有统计学意义（t=2.12，P<0.05）。术后头晕、恶心、呕吐、皮肤瘙痒发生率差异均无统计学意义（χ(2)=0.28、0.72、0.45、0.21，均P>0.05）。 结论： 超声引导下胸椎旁阻滞点距脊椎中轴越近，术后镇痛效果越好，但术后血压降低越明显，且肛门恢复排气时间越长；阻滞点距脊椎的中轴越远，术后镇痛效果下降，但术后血压下降减轻，且肛门恢复排气时间相对迅速。.
Keywords: Cholecystectomy, laparoscopic; Nerve block; Rehabilitation; Ultrasonography.