超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除术患者的镇痛效果  

ANALGESIC EFFECT OF ULTRASOUND-GUIDED SINGLE ERECTOR SPINAE PLANE BLOCK IN PATIENTS UNDERGOING VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY

作　　者：管伟 李希明[2] 刘中凯[2] 王月兰[1] GUAN Wei;LI Ximing;LIU Zhongkai;WANG Yuelan(Qianfoshan Hospital Affiliated to Shandong University,Jinan 250014,China)

机构地区：[1]山东大学附属千佛山医院,山东济南250014 [2]临沂市人民医院麻醉科

出　　处：《精准医学杂志》2019年第6期483-485,489,共4页Journal of Precision Medicine

基　　金：山东省医药卫生科技发展计划项目（2016WS0229）

摘　　要：目的 探讨超声引导下单次竖脊肌平面阻滞(ESPB)应用于胸腔镜下肺叶切除术的镇痛效果。方法选取本院择期于全麻下行胸腔镜下肺叶切除术患者60例,采用随机数字表法分为单次ESPB组(E组)和肋间神经阻滞(INB)组(I组),每组各30例。E组患者麻醉诱导前在超声引导下行单次ESPB(5g/L罗哌卡因30mL),I组患者麻醉诱导前在超声引导下行INB(5g/L罗哌卡因30mL)。观察并记录两组患者术后1h(T0)、6h(T1)、12h(T2)、24h(T3)、48h(T4)静息和活动时疼痛视觉模拟(VAS)评分,同时观察经静脉患者自控镇痛(PCIA)泵按压次数、不良反应及并发症发生情况。结果 与I组比较,E组神经阻滞操作时间明显缩短(t=6.023,P<0.05)。与I组比较,E组患者术后T1、T2时间点静息及活动时VAS评分均显著降低(F=4.588~5.640,P<0.05)。与I组比较,E组患者PCIA泵按压次数显著减少(t=2.455,P<0.05)。与I组比较,E组术后恶心呕吐的发生率明显降低(χ^2=6.298,P<0.05);而两组皮肤瘙痒等不良反应发生情况差异无统计学意义(P>0.05);两组患者均未出现气胸、局麻药中毒、内脏损伤、全脊麻等并发症。结论 超声引导下单次ESPB可安全用于胸腔镜下肺叶切除术患者的术后镇痛,并且镇痛效果良好,并发症更少。Objective To investigate the analgesic effect of ultrasound-guided single erector spinae plane block(ESPB)in video-assisted thoracoscopic lobectomy.Methods A total of 60 patients who underwent elective thoracoscopic lobectomy under general anesthesia were enrolled and randomly divided into ESPB group(group E with 30 patients)and intercostal nerve block(INB)group(group I with 30 patients).The patients in group E received ultrasound-guided single ESPB with 30 mL of 5 g/L ropivacaine before anesthesia induction,and those from group I received ultrasound-guided INB with 30 mL of 5 g/L ropivacaine.Vi-sual Analogue Scale(VAS)scores at the resting and active state were recorded at 1,6,12,24,and 48 hours after surgery(T 0,T 1,T 2,T 3,and T 4,respectively),and the number of patient-controlled intravenous analgesia(PCIA)pump pressings,adverse reactions,and complications were also recorded.Results Compared with group I,group E had a significantly shorter operation time of nerve block(t=6.023,P<0.05).Compared with group I,group E had significant reductions in VAS scores at the resting and active state at T 1 and T 2(F=4.588-5.640,P<0.05),as well as a significantly lower number of PCIA pump pressings(t=2.455,P<0.05).Compared with group I,group E had a significantly lower incidence rate of postoperative nausea and vomiting(χ^2=6.298,P<0.05),while there was no significant difference in the incidence rate of the other adverse reactions such as pruritus between the two groups(P>0.05).No complications,such as pneumothorax,local anesthetic intoxication,visceral injury,and general spinal anesthesia,were observed.Conclusion Ultrasound-guided single ESPB is a safe method for postoperative analgesia in patients undergoing video-assisted thoracoscopic lobectomy,with a good analgesic effect and few complications.

关 键 词：竖脊肌平面阻滞 肋间肌 神经传导阻滞 超声引导 镇痛 肺切除术 胸腔镜检查 

分 类 号：R614.4[医药卫生—麻醉学] R655.3[医药卫生—外科学]