椎旁神经阻滞和胸横肌平面阻滞在心脏换瓣手术中应用效果的对比  

Comparison of Effects of Paravertebral Nerve Block and Transverse Thoracic Muscle Plane Block in Cardiac Valve Replacement Surgery

作　　者：王思嘉 蔡宏伟[1] Wang Si-jia;Cai Hong-wei(Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《湖南师范大学学报（医学版）》2021年第2期120-123,共4页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的:比较B超引导下椎旁神经阻滞与胸横肌平面阻滞在全麻正中开胸心脏瓣膜置换术的应用效果。方法:选取2019年12月~2020年12月在我院施行择期开胸瓣膜置换术的患者60例。麻醉方式均采用全麻复合神经阻滞,依据神经阻滞方式不同将患者随机分成P(Paravertebral nerve block椎旁神经阻滞)组和T(Transverse thoracic muscle plane block胸横肌平面阻滞)组。记录入手术室(T0)、插管时(T1)、切皮时(T2)、劈胸骨时(T3)、切开心包时(T4)、关胸拉钢丝时(T5)各时间点MAP、HR以及术中舒芬太尼总量、血管活性药物使用量;记录患者拔除气管导管后2h、6h、12h、24h各时间点VAS评分(静息及动态);记录患者术后各项康复指标及不良反应情况。结果:(1)组内与T1相比,两组T2、T3的MAP降低,T组T4时的HR、MAP增高,组间相比P组T2、T3、T4的HR、MAP均低于T组;(2)P组术中舒芬太尼总量、术后各时间点VAS评分、苏醒时间及拔管时间均低于T组;(3)两组不良反应的差异无统计学意义。结论:正中开胸心脏换瓣手术中使用椎旁神经阻滞可以让血流动力学更加平稳,能够提供更好的术后镇痛,减少阿片类药物的使用,达到早苏醒早拔管的目的,更有利于患者的术后康复。Objective To compare the application effect of paravertebral nerve block and transverse thoracic muscle block under the guidance of B ultrasound in median thoracotomy heart valve replacement under general anesthesia.Methods A total of 60 patients who underwent elective thoracotomy valve replacement in our hospital from December 2019 to December 2020 were selected.Patients were randomly divided into P(Paravertebral nerve block)group and T(Transverse thoracic muscle plane block)group according to different ways of nerve block.MAP,HR,intraoperative total amount of sufentanil and the amount of vasoactive drugs were recorded at the time points of entry into the operating room(T0),intubation(T1),dermectomy(T2),thoracotomy(T3),pericardium incision(T4),chest closing and wire drawing(T5).VAS scores(resting and dynamic)were recorded at 2h,6h,12h and 24h after endotracheal catheter removal.Postoperative rehabilitation indexes and adverse reactions were recorded.Results Compared with T1,the MAP of T2 and T3 in the two groups decreased,while the HR and MAP of T group increased at T4.Compared with P group,the HR and MAP of T2,T3 and T4 in the two groups were lower than that of T group;The total amount of sufentanil,VAS score,awakening time and extubation time in group P were lower than those in group T;There was no significant difference in ADR between the two groups.Conclusion The use of paravertebral nerve block in midline thoracotomy cardiac surgery can make the hemodynamics more stable,can provide good postoperative analgesia,can reduce the use of opioids,achieve early recovery and extubation,and is more conducive to postoperative rehabilitation of patients.

关 键 词：心脏瓣膜手术 椎旁神经阻滞 胸横肌平面阻滞 

分 类 号：R614[医药卫生—麻醉学]