超声引导下竖脊肌平面阻滞在胸椎手术镇痛中的应用  

The application of ultrasound-guided erector spinae plane block analgesia in thoracic surgery

作　　者：张竞雄[1] 杨涛[1] 龙彦笑 倪旭青[1] 徐莉莉[2] ZHANG Jing-xiong;YANG Tao;LONG Yan-xiao;NI Xu-qing;XU Li-li(Department of Anesthesiology,the First Affiliated Hos-pital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第一医院麻醉科,浙江温州325000 [2]温州医科大学附属第一医院手术室,浙江温州325000

出　　处：《广东医学》2020年第24期2554-2558,共5页Guangdong Medical Journal

基　　金：温州市基础性科研项目(Y20180569)。

摘　　要：目的超声引导下竖脊肌平面阻滞(ESPB)和胸椎旁阻滞(TPVB)在胸椎手术镇痛中的应用及对患者背部皮肤感觉阻滞范围和消退时间的影响。方法选择100例拟行胸椎手术患者,随机分为两组。观察组(50例)采用超声引导下ESPB,对照组(50例)采用超声引导下TPVB。观察两组术后镇痛效果和安全性,以及阻滞后背部感觉阻滞范围和感觉阻滞消退时间差异。结果两组阻滞成功率、背部感觉阻滞消退时间、背部感觉阻滞效果比较均差异无统计学意义(P>0.05),观察组阻滞操作时间短于对照组(P<0.05),背部感觉阻滞起效时间长于对照组(P<0.05)。观察组阻滞后10、20 min阻滞面积大于对照组(P<0.05),阻滞30、60 min阻滞面积与对照组差异无统计学意义(P>0.05)。对照组术后活动状态下VAS评分与低于观察组(P<0.05),静息状态VAS评分、Ramsay评分比较差异无统计学意义(P>0.05)。对照组阻滞操作相关并发症发生率高于观察组(P<0.05)。结论超声引导下ESPB具有和TPVB相当但稍弱的背部感觉阻滞效果和术后镇痛效果,但操作简单,安全性高,更适合胸椎手术围术期镇痛。Objective To investigate the application of erector spinae plane block(ESPB) and thoracic para vertebral nerve block(TPVB) under the guidance of ultrasound in thoracic surgery analgesia, and their effects on the sensory block range and the time of regression. Methods 100 patients scheduled for thoracic spine surgery were randomly divided into two groups. In observation group(50 cases), the patients received ultrasound-guided ESPB, and those in control group(50 cases) received ultrasound-guided TPVB. The efficacy and safety of postoperative analgesia, the range of sensory block in the back and the time of block disappearance range between the two groups were observed and compared. Results There was no significant difference between the two groups in the success rate of block, the time of regression of back sensory or the effect of back sensory block(P>0.05). The operation time of observation group was significantly shorter than that of control group(P<0.05), with significantly longer onset time of dorsal sensory block(P<0.05). The areas of dorsal sensory block 10 and 20 minutes after block in observation group were significantly smaller than those in control group(P<0.05);but there was no significant difference between two groups 30 or 60 minutes after block(P>0.05). The VAS score in active state of control group was significantly lower than that of observation group(P<0.05), but there was no significant difference between two groups in the VAS score in resting state or Ramsay score(P>0.05). The incidence of block related complications in control group was significantly higher than that in observation group(P<0.05). Conclusion Ultrasound-guided ESPB has the same effect but weaker back sensory block and postoperative analgesia efficacies as TPVB. But the operation is simple and the safety is high, so it is more suitable for perioperative analgesia of thoracic spine operation.

关 键 词：竖脊肌平面阻滞 胸椎旁阻滞 胸椎手术 背部 感觉阻滞 镇痛 

分 类 号：R735.1[医药卫生—肿瘤] R614.4[医药卫生—临床医学]