超声引导下前锯肌平面阻滞对胸腔镜肺癌根治术术后镇痛及炎性反应的影响  

Effect of ultrasound-guided serratus anterior plane block on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic radical resection for lung cancer

作　　者：孟杰[1] 肖航[1] 曾宪伟[1] 陈辉[1] MENG Jie;XIAO Hang;ZENG Xian-wei;CHEN Hui　(Department of Anesthesiology,Xiaogan Central Hospital,Xiaogan,Hubei　432000,China)

机构地区：[1]孝感市中心医院麻醉科,湖北孝感432000

出　　处：《临床肺科杂志》2018年第5期913-916,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨超声引导下前锯肌平面阻滞(SAPB)对胸腔镜肺癌根治术术后镇痛及炎性反应的影响。方法选择拟行胸腔镜肺癌根治术的ASA分级Ⅰ-Ⅱ级患者60例采用随机数字法分为前锯肌平面阻滞组(SP组,n=30)和对照组(C组,n=30)。手术完成后超声引导下穿刺至前锯肌平面,SP组推注0.375%罗哌卡因20m L,C组推注生理盐水20m L。术后所有患者均采用静脉自控镇痛(PICA)。记录术后2h(T_1)、术后4h(T_2)、术后12h(T_3)、术后24h(T_4)患者的静止时和咳嗽时疼痛评分,术后24h镇痛用舒芬太尼的量,记录患者镇痛相关不良反应;手术完成时(T_0)、术后2h(T_1)、术后4h(T_2)、术后12h(T_3)、术后24h(T_4)抽取患者静脉血检测血清IL-6、IL-10的浓度。对患者进行疼痛评分和记录不良反应时观察者和患者均采用盲法。结果 SP组静止时T_1、T_2、T_3、T_4疼痛VAS评分和咳嗽时T_1、T_2、T_3疼痛VAS评分明显小于C组(P<0.05),SP组术后镇痛舒芬太尼用量明显小于C组(P<0.05);与手术完成时(T_0)比较,T_1、T_2、T_3、T_4两组患者血清IL-6、IL-10浓度均明显升高。与C组比较,T_1、T_2、T_3、T_4时SP组IL-6浓度明显降低(P<0.05)、IL-10浓度明显升高(P<0.05)。两组患者不良反应比例无明显差异(P>0.05)。结论超声引导下前锯肌平面阻滞联合静脉自控镇痛,能为胸腔镜肺癌根治术提供良好的术后镇痛,并减轻患者炎性反应。Objective To investigate the effect of ultrasound-guided serratus anterior plane block(SAPB)on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic radical resection for lung cancer.Methods 60 ASA patients undergoing thoracoscopic radical resection for lung cancer were randomly divided into the SAPB group(the group SP,n=30)and the control group(the group C,n=30).After the completion of operation,all of them underwent ultrasound-guided SAPB.The group SP was given 0.375%ropivacaine 20ml,while the group C was given saline 20mL.All patients underwent intravenous analgesia(PICA)with sufentanil after surgery.2h(T 1),4h(T 2),12h(T 3),and 24h(T 4)after surgery,the coughing and resting visual analogue scale(VAS)and the consumption of sufentanil within 24h were evaluated,and the adverse effect was also recorded.Blood samples via internal jugular at surgery finish(T 0),T 1,T 2,T 3 and T 4 serum interleukin-6(IL-6)and IL-10 were determined by ELSIA.The patients and investigators were all blind to the allocation.Results Compared with the C group,the resting VAS at T 1,T 2,T 3,T 4 and the coughing VAS at T 1,T 2,T 3 were significantly lower in the group SP(P<0.05).The consumption of sufentanil within 24h was significantly lower in the group SP(P<0.05).Compared with T 0,the serum IL-6 and IL-10 concentrations at T 1,T 2,T 3 and T 4 were all significantly higher in both groups.Compared with the C group,serum IL-6 concentration was significantly lower and serum IL-10 concentration was significantly higher at T 1,T 2,T 3 and T 4 in the group SP(P<0.05).There was no significant difference in adverse reaction between the two groups(P>0.05).Conclusion Ultrasound-guided serratus anterior plane block is helpful to enhance the postoperative analgesic effect in patients undergoing thoracoscopic radical resection for lung cancer,and can reduce inflammatory response.

关 键 词：前锯肌平面阻滞 术后镇痛 炎性反应 胸腔镜肺癌根治术 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]