超声引导下前锯肌平面阻滞对胸腔镜手术患者术后镇痛的影响  

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery

作　　者：商丽华 肖甄男 龙波[1] Shang Lihua;Xiao Zhennan;Long Bo(Department of Anesthesia,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《中国医师进修杂志》2018年第9期819-822,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 观察前锯肌平面阻滞（SAPB）对胸腔镜手术术后镇痛的效果.方法 选择2017年10月至2018年4月择期接受全身麻醉下胸腔镜肺癌根治术的患者60例,采用随机数字表法将患者分为SAPB组（30例）及对照组（30例）,全身麻醉诱导后经超声引导施行术侧SAPB,SAPB组注射0.5％的罗哌卡因20 ml,对照组注射等量0.9％氯化钠注射液,术后两组均配制静脉镇疼泵.分别于术后1、2、4、8、12、24和48 h行视觉模拟评分（VAS）和舒适度评分（BCS）,同时记录不良反应的发生情况.记录术中瑞芬太尼和术后48 h内额外镇痛药需求量.结果 SAPB组的VAS在术后1、2、4、8和12 h均低于对照组[1 h：（2.70±0.92）分比（5.10±2.04）分、2 h：（2.80±1.00）分比（5.13±1.78）分、4 h：（3.07±1.17）分比（4.93±1.53）分、8 h：（3.13±1.07）分比（4.63±1.47）分、12 h：（2.87±0.73）分比（3.83±1.29）分]（P〈0.05）;SAPB组的BCS在术后1、2、4、8和12 h优于对照组[1 h：（1.90±0.66）分比（0.93±0.91）分 、2 h：（2.03±0.41）分比（0.90±0.80）分、4 h：（1.90±0.40）分比（1.07±0.69）分、8 h：（1.97±0.32）分比（1.20±0.66）分、12 h：（2.03±0.18）分比（1.73±0.45）分],差异有统计学意义（P〈0.05）;且SAPB组术中瑞芬太尼用量及48 h内额外镇痛药需求量均明显少于对照组[（0.23±0.03）mg比（0.34±0.03）mg、（26.67±25.37）mg比（40.00±24.21）mg],差异有统计学意义（P〈0.05）;两组不良反应发生率比较差异无统计学意义（P〉0.05）.结论 SAPB可减轻胸腔镜肺癌根治术患者术后早期疼痛,提高患者的舒适度,加强术后镇痛的效果并减少术后止疼药的使用量.Objective To investigate the effect of ultrasound-guided serratus plane block （SAPB） on efficacy of postoperative analgesia in patients undergoing video- assisted thoracoscopic surgery. Methods Sixty patients scheduled for video- assisted thoracoscopic radical resection of lung cancer under general anesthesia from October 2017 to April 2018 were divided into 2 groups by random digits table method with 30 cases each： SAPB group and control group. After induction of anesthesia, ultrasound-guided homolateral SAPB was performed, and 0.5% ropivacaine 20 ml was injected in SAPB group, while the equal volume of normal saline was used instead in control group. The patients received intravenous analgesia after operation in 2 groups. The scores of visual analogue score （VAS） and Bruggrmann comfort score （BCS） were evaluated at 1, 2, 4, 6, 12, 24 and 48 h after operation. The consumption of additional pain medication within 48 h after operation and remifentanil during operation were recorded. The adverse effects were also recorded. Results The VAS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly lower than those in control group： （2.70 ± 0.92） scores vs. （5.10 ± 2.04） scores, （2.80 ± 1.00） scores vs. （5.13 ± 1.78） scores, （3.07 ± 1.17） scores vs. （4.93 ± 1.53） scores, （3.13 ± 1.07） scores vs. （4.63 ± 1.47） scores and （2.87 ± 0.73） scores vs. （3.83 ± 1.29） scores, P 〈0.05; the BCS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly better than those in control group： （1.90 ± 0.66） scores vs. （0.93 ± 0.91） scores, （2.03 ± 0.41） scores vs. （0.90 ± 0.80） scores, （1.90 ± 0.40） scores vs. （1.07 ± 0.69） scores, （1.97 ± 0.32） vs. （1.20 ± 0.66） scores and （2.03 ± 0.18） scores vs. （1.73 ± 0.45） scores, and there were statistical differences （P〈0.05）. The dose of remifentanil consumption of additional pain medication within 48 h in SAPB group were significant

关 键 词：肺肿瘤 胸腔镜 神经肌肉阻滞 镇痛 超声检查 

分 类 号：R614[医药卫生—麻醉学]