竖脊肌平面阻滞镇痛与硬膜外阻滞镇痛对胸腔镜术后患者恢复质量及疼痛状况的影响  

Effects of erector spinae plane block and epidural block on quality of recovery and analgesia after thoracoscopic surgery

作　　者：郭淼森 李强[2] 曾维安[2] GUO Miaosen;LI Qiang;ZENG Weian(Department of Anesthesiology,Nanhai Hospital of Southern Medical University,Foshan 528200,China;不详)

机构地区：[1]南方医科大学南海医院麻醉科,北京100191 [2]中山大学肿瘤防治中心麻醉科,广州510060

出　　处：《实用医学杂志》2020年第6期774-778,共5页The Journal of Practical Medicine

基　　金：北京医学奖励基金项目(编号:YXJL-2019-0163-0020)。

摘　　要：目的比较连续竖脊肌平面阻滞镇痛与连续硬膜外镇痛对胸腔镜手术患者术后恢复质量及疼痛情况的影响。方法70例择期接受胸腔镜手术(video-assisted thoracic surgery,VATS)的患者,随机分为两组,在术前分别进行竖脊肌平面置管(ESPB组)和硬膜外置管(EB组),并给与相应镇痛方式。观察并记录的主要指标为:术前、术后第1天和第2天的QoR-15评分,次要指标为术后静息及咳嗽状态下的疼痛NRS评分(包括术后拔管即刻、离开麻醉复苏室时、术后6、24、48 h)。其他次要指标包括:神经阻滞操作所需时间及镇痛不良反应等。结果EB组术后第1天和第2天的QoR-15评分均高于ESPB组,差异有统计学意义。EB组术后各时点静息及咳嗽状态下的疼痛NRS均较低于ESPB组,差异具有统计学意义。结论胸腔镜术后采用硬膜外镇痛的患者比竖脊肌平面阻滞镇痛的患者具有较高的术后恢复质量,具有较好的镇痛效果,是VATS术后镇痛的更好选择。Objective To compare the effects of continuous erector spinae plane block(ESPB)and continuous epidural block(EB)on the quality of postoperative recovery and analgesia in patients undergoing thoracoscopic surgery.Methods Seventy patients who underwent elective video-assisted thoracic surgery(VATS)were randomly assigned into ESPB group and EB group.The primary index was the QoR-15 score of patients the day before surgery,the first and second day after surgery.The secondary indexwas NRS scores of postoperative pain(including that after extubation,discharge from PACU,6,24 and 48 hours after surgery).Other secondary indexes included:time required for nerve block operation and adverse effects caused by analgesia.Results There were significantly higher QoR-15 scores in EB group on the first and second postoperative days than those in ESPB group.While at rest or coughing,NRS scoreof patients in EB group were significantly lower than that in ESPB group at all the time points.Conclusion Patients with EB after thoracoscopy have higher postoperative recovery quality and better analgesic effects than those with ESPB,which is a better choice for analgesia after VATS.

关 键 词：竖脊肌平面阻滞 硬膜外阻滞 胸腔镜 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]