超声引导下双侧多点竖脊肌平面阻滞在后路脊柱侧凸矫正融合术中的应用  

Application of erector spinae plane block to the posterior scoliosis correction and fusion with the guidance of ultrasonic

作　　者：刘苹 吴茜 杨磊[1] 姚尚龙[1] LIU Ping;WU Qian;YANG Lei;YAO Shanglong(Department of Anesthesiology,Xiehe Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,湖北武汉430022

出　　处：《中国医学物理学杂志》2020年第11期1394-1397,共4页Chinese Journal of Medical Physics

基　　金：贝朗麻醉科学研究基金(BBDF-2018-005)。

摘　　要：目的:探讨超声引导下双侧多点竖脊肌平面阻滞(ESPB)在后路脊柱侧凸矫正全麻手术中的应用和对术后镇痛的影响。方法:选取择期后路脊柱侧凸矫正融合术患者40例,ASA分级Ⅰ~Ⅱ,按照随机数字表法将所有患者分为ESPB组(E组)和对照组(C组),每组20例。E组于全身麻醉诱导前30 min分别行双侧T5和T10水平的ESPB,C组注射等量生理盐水。注药20 min后使用针刺痛觉评估法监测感觉阻滞平面。两组患者均采用相同的麻醉诱导及麻醉维持方案,术中均采用Narcotrend监测麻醉镇静深度。术后均行舒芬太尼自控静脉镇痛。记录两组患者术中麻醉药物用量、术后苏醒时间、术后2、4、6、12、24 h静息视觉模拟评分(VAS评分)和24 h PCA镇痛泵舒芬太尼用量及PCA按压次数;相关不良反应(恶心呕吐、呼吸抑制)以及阻滞相关并发症(穿刺部位感染、血肿、局麻药中毒)。结果:E组患者术中麻醉药物用量、苏醒时间、术后2、4、6、12 h VAS评分和PCA舒芬太尼用量及PCA按压次数均低于C组(P<0.05)。但术后24 h VAS评分两组比较差异无统计学意义。E组未出现穿刺部位感染、血肿、局麻药中毒等并发症。结论:超声引导下双侧多点ESPB在后路脊柱侧凸矫正融合术中能提供良好的镇痛,可以缩短麻醉苏醒时间,降低围术期阿片类药物的使用。Objective Under the guidance of ultrasonic, to explore the application of erector spinae plane block to the general anesthesia surgery of posterior scoliosis correction and fusion and its effects on postoperative analgesia. Methods A total of40 patients with posterior scoliosis correction and fusion were sampled, and these patients are all in level I-II of the ASA class. According to random number table, all patients were divided into ESPB group(group E) and control group(group C),with 20 patients in each group. In E group, ESPB was conducted at the level of T5 and T10 when 30 minutes before the anesthesia induction, while in group C, the same amount of normal saline was injected. 20 minutes after the injection, the method of evaluating pain with acupuncture was used to monitor the sensory blockade. Both groups underwent the same induction and maintenance of anesthesia, narcotrend was used to monitor the depth of anesthesia and sedation during the operation, and sufentanil was adopted for intravenous patient-controlled analgesia after the operation. The dosage of anesthetic, time to awaken, visual analogue scales at rest(2, 4, 6, 12, and 14 h after operation respectively), the 24 h PCA(patient-controlled analgesia) dosage of sufentanil, and the times of PCA compression were recorded. The adverse reactions(nausea and vomiting, respiratory depression) and the complications(infection of puncture site, hematoma, local anesthetic poisoning) were also recorded. Results The dosage of anesthetic, time to awaken, VAS score, the dosage of sufentanil and the times of PCA compression in E group are all less than those in group C(P<0.05). However, the differences in VAS score at24 h after the operation between the two groups have no statistical significance. In E group, there were no complications such as infection of puncture site, hematoma and local anesthetic poisoning. Conclusion Under the guidance of ultrasound, ESPB can provide efficient analgesia for the posterior scoliosis correction and fusion, shorten time to awaken

关 键 词：超声引导 竖脊肌平面阻滞 后路脊柱侧凸矫正融合术 术后镇痛 

分 类 号：R614.2[医药卫生—麻醉学]