老年胸腔镜术后连续前锯肌平面阻滞与胸椎旁阻滞镇痛效果比较  

Analgesic effect comparison between continuous serratus plane block and parathoracic block after thoracoscopic surgery in elderly patients

作　　者：张隆盛[1] 张楷弘 杨铎 张欢楷[1] 林旭林 林耿彬[1] 黄志良[1] ZHANG Longsheng;ZHANG Kaihong;YANG Duo;ZHANG Huankai;LIN Xulin;LIN Gengbin;HUANG Zhiliang(Department of Anesthesiology,Jieyang People′s Hospital,Jieyang 522000,China;不详)

机构地区：[1]揭阳市人民医院麻醉科,广东揭阳522000 [2]右江民族医学院研究生学院,广西百色533000

出　　处：《实用医学杂志》2021年第5期654-659,共6页The Journal of Practical Medicine

基　　金：广东省医学科学技术研究基金(编号:B2018001,A2021400);广东省中医药局科研项目(编号:20191409);2020年揭阳市卫生医疗类项目(编号:YLWS005)。

摘　　要：目的比较老年胸腔镜术后连续前锯肌平面阻滞与胸椎旁阻滞的镇痛效果。方法选择胸腔镜手术老年患者,随机分为CS组和CT组。CS组患者在麻醉诱导前行连续前锯肌平面阻滞,CT组行连续胸椎旁阻滞。记录阻滞操作时间、一次穿刺成功率;记录术后2、6、12、24、48 h静止和咳嗽疼痛VAS评分;记录术后48 h内PCA次数、舒芬太尼补救性镇痛例数、满意度评分;术前24 h和术后24、48 h评估患者睡眠质量;记录术后48 h内不良反应发生情况。结果与CT组比较,CS组阻滞操作时间明显降低(P<0.05),一次穿刺成功率明显升高(P<0.05),满意度明显升高(P<0.05),低血压发生率明显降低(P<0.05),两组患者术后各时间点静止和咳嗽疼痛VAS评分、PCA次数和舒芬太尼补救性镇痛例数差异均无统计学意义(P>0.05)。结论连续前锯肌平面阻滞与连续胸椎旁阻滞均能减轻老年患者胸腔镜术后疼痛,镇痛效果相当,但前锯肌平面阻滞操作时间更短,一次穿刺成功率高,镇痛期间低血压发生率低且改善睡眠质量,患者满意度高。Objective To compare the analgesic effects between continuous serratus plane block and parathoracic block after thoracoscopic surgery in elderly patients.Methods Elderly patients undergoing thoracoscopic surgery in our hospital were selected and randomly divided into group S and group T.The patients in group S received continuous serratus plane block under ultrasound guidance before anesthesia induction,while group T continuous thoracic paraspinal block.Time of block operation and success rate of one puncture were recorded.VAS scores of at rest and cough pain 2,6,12,24 and 48 h after the operation were recorded.Pressing times of analgesia pump,the number of cases of sufentanil remedial analgesia and the score of satisfaction were recorded.PSQI scores 24 h before,24 h and 48 h after operation,the incidence of adverse reactions within 48 hours after the operation were recorded.Results Block operation time was significantly reduced(P<0.05);but success rate of one puncture and satisfaction rate was significantly increased(P<0.05)and the incidence of hypotension was significantly reduced(P<0.05)in group S when compared with those in group T.There was no significant difference in terms of VAS score of at rest and cough pain,times of pressing analgesia pump and the number of sufentanil remedial analgesia cases between the two groups(P>0.05).Conclusion Both of the two methods can reduce the pain after thoracoscopic surgery in the elderly,and the analgesic effect of the two methods is similar.In contrast,continuous serratus plane block has shorter operation time,higher success rate of puncture,lower incidence of hypotension during analgesia,improved sleep quality and higher satisfaction.

关 键 词：老年胸腔镜 连续前锯肌平面阻滞 连续胸椎旁阻滞 镇痛效果 

分 类 号：R614[医药卫生—麻醉学]