胸横肌平面阻滞联合全身麻醉对非体外循环冠脉搭桥手术围术期的影响  

Effects of transversus thoracic plane block combined with general anesthesia on the perioperative period of off-pump coronary artery bypass surgery

作　　者：叶伟光[1] 王天龙[1] 兰飞[1] 于巍[1] 尹橙[1] Ye Weiguang;Wang Tianlong;Lan Fei;Yu Wei;Yin Chen(Department of Anesthesiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《北京医学》2020年第6期519-522,共4页Beijing Medical Journal

基　　金：北京市卫生和计划生育委员会“老年重大疾病关键技术研究”(PXM2017_026283_000002);北京市医院管理局“登峰”人才培养计划(DFL20150802)。

摘　　要：目的观察双侧胸横肌平面阻滞(transversus thoracic plane block,TTPB)联合全身麻醉对非体外循环下冠脉搭桥术(off-pump coronary artery bypass grafting,OPCABG)围术期的影响。方法选取2018年10月至2019年4月首都医科大学宣武医院择期行OPCABG的患者40例,采用随机数字表法随机分为单纯全身麻醉组(A组,20例)和全身麻醉复合双侧TTPB组(B组,20例)。记录两组在术中不同阶段舒芬太尼靶控浓度及血流动力学的变化,并记录术中舒芬太尼的用量,术后镇痛VAS评分,术后气管导管保留时间和重症监护室(intensive care unit,ICU)停留时间。结果与A组相比,B组术中舒芬太尼的靶控浓度降低,循环波动小,舒芬太尼的用量明显减少(P<0.01),术后气管导管保留时间及ICU停留时间也显著缩短(P<0.05),术后12 h、24 h静息及运动VAS评分均显著低于A组(P<0.05)。结论全身麻醉复合双侧TTPB用于OPCABG有利于维持术中循环稳定,降低术中舒芬太尼靶控浓度,减少麻醉镇痛药物用量,利于患者术后早期恢复。Objective To observe the effects of transversus thoracic plane block(TTPB)combined with general anesthesia on the perioperative period of off-pump coronary artery bypass grafting(OPCABG).Methods Forty patients scheduled for elective OPCABG were randomly divided into general anesthesia group(Group A,n=20)and general anesthesia combined with TTPB(Group B,n=20).The TCI concentration of sufentanil and hemodynamic parameter during the period of operation were recorded.Meanwhile,other data were recorded,such as the consumption of sufentanil during operation,score of postoperative analgesia,the time of endotracheal tube retention and intensive care unit(ICU)stay.Results Compared with group A,the TCI concentration of sufentanil and frequency of hemodynamic abnormalities were lower during operation in group B.The consumption of sufentanil was less during operation in group B(P<0.01).Moreover,the time of endotracheal tube retention and ICU stay were shorter in group B(P<0.05).Scores of postoperative analgesia in group B were also lower than that in group A.Conclusions General anesthesia combined with TTPB in OPCABG is beneficial to maintain hemodynamic stabilization,decrease the TCI concentration of sufentanil and dosage of anesthetic analgesics,and can promote early recovery.

关 键 词：胸横肌平面阻滞 非体外循环下冠脉搭桥术 

分 类 号：R614[医药卫生—麻醉学]