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目的:研究老年患者胸腔镜肺叶切除术（video-assisted thoracic surgery, VATS）前行胸椎旁神经阻滞（paravertebral nerve block, PVB）所需罗哌卡因的最佳药物浓度。方法:选取南京医科大学附属淮安第一医院2019年1月至2019年12月于全身麻醉下行VATS的老年患者80例，采用随机数字表法将患者分为4组（每组20例）：0.25%罗哌卡因PVB复合全身麻醉组（A组）、0.33%罗哌卡因PVB复合全身麻醉组（B组）、0.50%罗哌卡因PVB复合全身麻醉组（C组）、单纯全身麻醉组（D组）。记录各组患者拔管后5 min（T1）、拔管后2 h（T2）、拔管后4 h（T3）、拔管后24 h（T4）静息及咳嗽时的VAS疼痛评分，术中舒芬太尼和间羟胺的用量，苏醒时间和拔管时间，PACU补救镇痛的例数，苏醒期躁动以及术后恶心、呕吐的例数。结果:与A组和D组比较：B组与C组患者静息与咳嗽时VAS疼痛评分明显下降，PACU补救镇痛的例数明显减少，苏醒期躁动例数减少（n P<0.05）；C组术中舒芬太尼和间羟胺用量减少，苏醒时间、拔管时间缩短（n P<0.05）。与B组比较，C组术中舒芬太尼和间羟胺用量减少，苏醒时间、拔管时间缩短（n P0.05）。n 结论:0.33%罗哌卡因与0.50%罗哌卡因行PVB均能减轻老年患者VATS术后疼痛。0.50%罗哌卡因更有利于减少围手术期镇痛药使用，维持血流动力学稳定，促进患者术后快速苏醒及拔管，推荐其为老年患者VATS的最佳药物浓度。“,”Objective:To investigate the optimal concentration of ropivacaine for paravertebral nerve block (PVB) in elderly patients before video-assisted thoracic surgery (VATS).Methods:A total of 80 elderly patients who underwent VATS under general anesthesia from January 2019 to December 2019 in the Affiliated Huai'an First Hospital of Nanjing Medical University were enrolled. According to the random number table method, they were divided into four groups (n n=20): a 0.25% ropivacaine for PVB combined with general anesthesia group (group A), a 0.33% ropivacaine for PVB combined with general anesthesia group (group B), a 0.50% ropivacaine for PVB combined with general anesthesia group (group C), and a simple general anesthesia group (group D). Their Visual Analog Scale (VAS) scores at resting and coughing 5 min (T1), 2 h (T2), 4 h (T3), and 24 h after extubation (T4), sufentanil and metaraminol doses during operation, recovery and extubation times, as well as the number of rescue analgesia cases in post-anesthesia care unit (PACU), and the number of emergence agitation cases, postoperative nausea and vomiting were recorded.n Results:Compared with groups A and D, patients in groups B and C presented remarkable decreases in VAS scores at resting and coughing, the number of analgesia rescue cases in PACU and the number of emergency agitation cases (n P<0.05); group C also showed decreased doses of sufentanil and metaraminol and reduced recovery and extubation times (n P<0.05). Compared with group B, the doses of sufentanil and metaraminol and the recovery and extubation times were shortened in group C (n P0.05).n Conclusions:Both 0.33% and 0.50% ropivacaine in PVB can relieve postoperative pain in elderly patients after VATS. But 0.50% ropivacaine is more effective in reducing the use of perioperative analgesics, maintaining hemodynamic stability and promoting the rapid recovery and extubation of patients after surgery, which is recommended as the optimal concentration for elderly patients with VATS.