前锯肌平面阻滞对胸腔镜术后慢性疼痛的影响:前瞻性随机对照研究  

Effect of Serratus Plane Block on Chronic Pain After Thoracoscopic Surgery:a Prospective Randomized Controlled Study

作　　者：时蓉[1] 吴安石[1] 王云[1] 马丹旭[1] 杨宜南[1] 戈晓东[1] Shi Rong;Wu Anshi;Wang Yun(Department of Anesthesiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院麻醉科,北京100020

出　　处：《中国微创外科杂志》2020年第10期871-874,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：首都临床特色应用研究(Z181100001718222)。

摘　　要：目的探讨前锯肌平面阻滞对胸腔镜术后慢性疼痛的影响。方法纳入2018年6月~2019年10月159例全麻择期初次胸腔镜手术,ASAⅠ~Ⅱ级。随机分成前锯肌平面阻滞组(S组,n=80)和对照组(C组,n=79)。S组麻醉诱导前行超声引导下患侧前锯肌平面阻滞,注入0.5%罗哌卡因20 ml,C组不进行前锯肌平面阻滞。2组麻醉诱导和全麻维持、术后患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)相同。记录2组术后24 h、48 h PCIA按压次数。术后2个月电话随访,记录慢性疼痛情况,并评价其对日常生活的影响和处理措施等级。结果与C组比较,S组术后镇痛泵按压次数明显减少[0~24 h:3(3~6)vs.9(7~12)次,Z=-10.794,P=0.000;0~48 h:8(6~8)vs.20(17~25)次,Z=-10.457,P=0.000]。2组术后慢性疼痛发生率差异无显著性[45.0%(36/80)vs.46.8%(37/79),χ^2=0.054,P=0.816],但S组术后慢性疼痛对日常生活影响程度减轻(Z=-3.629,P=0.000),疼痛处理措施等级降低(Z=-3.790,P=0.000)。结论前锯肌平面阻滞不能降低胸腔镜术后慢性疼痛发生率,但可减轻术后慢性疼痛程度。Objective To investigate the effect of serratus plane block on chronic pain after thoracoscopic surgery.Methods From June 2018 to October 2019,one hundred and fifty-nine patients with ASAⅠ-Ⅱgrade underwent thoracoscopic surgery for the first time under general anesthesia.They were randomly divided into group C(n=79)and group S(n=80).Patients in group C were routinely induced by anesthesia and maintained under general anesthesia.For patients in group S,ultrasound-guided serratus plane block of the affected side was performed before induction and 0.5%ropivacaine(20 ml)was injected.Patient controlled intravenous analgesia(PCIA)was used for both groups.PCIA pressing times within 24 h and 48 h were recorded.The patients were followed up for 2 months by telephone after operation.The occurrence of postoperative chronic pain was recorded,and the effect of pain on daily life and grade of treatment measures were evaluated.Results As compared with the group C,the times of PCIA pressing was significantly reduced in the group S within 24 h and 48 h after operation[0-24 h:3(3-6)vs.9(7-12)times,Z=-10.794,P=0.000;0-48 h:8(6-8)vs.20(17-25)times,Z=-10.457,P=0.000].There was no significant difference in the incidence of postoperative chronic pain between the two groups[45.0%(36/80)vs.46.8%(37/79),χ^2=0.054,P=0.816].But the influence of postoperative chronic pain on daily life and the level of pain management in the group S was reduced(Z=-3.629,P=0.000;Z=-3.790,P=0.000).Conclusion Serratus plane block cannot reduce the incidence of chronic pain after thoracoscopic surgery,but can alleviate the degree of chronic pain.

关 键 词：前锯肌平面阻滞 胸腔镜手术 慢性疼痛 

分 类 号：R61[医药卫生—外科学]