超声引导下前锯肌阻滞与胸椎硬膜外阻滞治疗急性胸廓切开术后疼痛的疗效比较  

Ultrasound-guided serratus anterior plane block versus thoracic epidural block in the treatment of acute pain after thoracotomy

作　　者：单玉兰 周晓林 朱小兰 徐小青 SHAN Yulan;ZHOU Xiaolin;ZHU Xiaolan;XU Xiaoqing(Department of Anesthesiology,Affiliated Haian Hospital,Nantong University,Nantong,Jiangsu Province 226600,China)

机构地区：[1]南通大学附属海安医院麻醉科,江苏海安226600 [2]南通大学附属海安医院超声科,江苏海安226600 [3]南通市中医院疼痛科

出　　处：《介入放射学杂志》2020年第5期472-476,共5页Journal of Interventional Radiology

摘　　要：目的评估超声引导下前锯肌平面阻滞(SAPB)与胸段硬膜外阻滞治疗胸廓切开术后急性疼痛的有效性和安全性。方法该研究在2017年2月至2018年12月期间进行全身麻醉下计划进行胸廓切开术的61例患者被随机分配两组,前锯肌阻滞组32例,胸段硬膜外阻滞组29例。前锯肌阻滞组患者在术后气管导管拔除前进行超声引导下前锯肌浅层肌间隙注射0.25%左旋布比卡因30 mL,而后在肌间隙泵注0.125%左旋布比卡因5 mL/h;胸段硬膜外阻滞组通过术前清醒状态置入胸段硬膜外导管,在术后气管导管拔除前在导管内推注0.25%左布比卡因15 mL,随后泵注的0.125%左旋布比卡因5 mL/h。在术后24 h内记录患者平均动脉压和VAS疼痛评分以及使用吗啡的剂量。结果前锯肌阻滞组术前与术后相比,患者平均动脉血压没有显著变化(P=0.147),而胸段硬膜外阻滞组则显著下降(P=0.002);两组的VAS评分以及消耗吗啡的总剂量没有显著统计学差异。结论前锯肌平面阻滞相对于胸段硬膜外阻滞是治疗急性胸廓切开术后疼痛安全有效的镇痛方案。Objective To compare the efficacy and safety of ultrasound-guided serratus anterior plane block(SAPB)with those of thoracic epidural anesthesia(TEA,i.e.thoracic epidural block)in treating acute pain after thoracotomy.Methods A total of 61 patients,who were scheduled to receive thoracotomy under general anesthesia during the period from February 2017 to December 2018,were randomly divided into SAPB group(n=32)and TEA group(n=29).For the patients in SAPB group,ultrasound-guided injection of 30 mL of 0.25%levobupivacaine into the superficial muscle space of the anterior serratus was adopted before the trachea cannula was removed after operation,which was followed by pump-injection of 0.125%levobupivacaine at a velocity of 5 mL/h.For the patients in TEA group,a thoracic epidural catheter was inserted into the thoracic spine when the patients were in waking state,and through this epidural catheter 15 mL of 0.25%levobupivacaine was injected before the trachea cannula was removed,which was followed by pump-injection of 0.125%levobupivacaine at a velocity of 5 mL/h.The patient's heart rate,mean arterial pressure,VAS pain score,and the total used dose of morphine within 24 hours after surgery were recorded.Results In SAPB group the postoperative mean arterial pressure showed no obvious changes when compared with the preoperative one(P=0.147),while in TEA group the postoperative mean arterial pressure dropped significantly(P=0.002).No statistically significant differences in VAS score and the total used dose of morphine existed between the two groups.Conclusion In treating acute pain after thoracotomy,SAPB is safer and more effective than TEA.

关 键 词：超声引导 胸廓切开术 急性疼痛 胸段硬膜外阻滞 前锯肌阻滞 

分 类 号：R734[医药卫生—肿瘤] R441.1[医药卫生—临床医学]