胸骨旁胸大肌肋间肌平面阻滞与肋间神经阻滞在婴幼儿心脏手术后镇痛效果的比较  

Comparison of the efficacy of parasternal pectoralis major intercostal muscle plane block and intercostal nerve block for postoperative analgesia after cardiac surgery in infants

作　　者：黎昆伟[1] 邓恋[1] 苏丹晨[1] 陈祥楠[1] 蔡明阳[1] 张海红 梁素梅 胡祖荣[1] LI Kunwei;DENG Lian;SU Danchen;CHEN Xiangnan;CAI Mingyang;ZHANG Haihong;LIANG Sumei;HU Zurong(Guangdong Women And Children’s Hospital,Guangzhou 511442,China;不详)

机构地区：[1]广东省妇幼保健院,广东广州511442

出　　处：《现代医院》2021年第7期1122-1125,共4页Modern Hospitals

基　　金：广东省中医药局科研项目(20211052)。

摘　　要：目的比较胸骨旁胸大肌肋间肌平面阻滞与肋间神经阻滞在婴幼儿心脏手术后镇痛效果。方法选取拟择期行室间隔缺损修补术或房间隔缺损修补术的6个月~3岁的儿童60例,随机分为胸骨旁胸大肌肋间肌平面阻滞组(PPMIMP)和肋间神经阻滞组(ICNB),每组30例。麻醉诱导后,PPMIMP组患儿在超声引导下行双侧胸骨旁胸大肌肋间肌平面阻滞,ICNB组患儿在超声引导下行双侧肋间神经阻滞。两组患儿均常规使用舒芬太尼行护士自控静脉镇痛(NCIA),所有患儿术后若FLACC疼痛行为评分≥5分,均采用曲马多注射液进行补救镇痛,记录两组不同时间点的舒芬太尼用量,FLACC疼痛行为评分,Ramsay镇静评分,术后24小时内补救镇痛次数以及恶心呕吐、呼吸抑制、过度镇静等不良反应发生情况,记录两组是否出现局麻药中毒、气胸、皮下血肿等神经阻滞并发症。结果两组患儿在镇痛开始后2、4 h的舒芬太尼用量、FLACC疼痛行为评分、Ramsay镇静评分的差异无统计学意义(P>0.05),镇痛开始后8、12、18、24 h舒芬太尼用量PPMIMP组明显少于ICNB组(P<0.05);镇痛开始后8、12、24 h的FLACC疼痛行为评分、Ramsay镇静评分PPMIMP组明显低于ICNB组(P<0.05);术后24 h内补救镇痛率PPMIMP组明显低于ICNB组(P<0.05)。PPMIMP组不良反应发生率明显低于ICNB组(P<0.05)且均未见神经阻滞并发症。结论与肋间神经阻滞相比,胸骨旁胸大肌肋间肌平面阻滞用于婴幼儿心脏手术后镇痛,不仅作用时间更长,术后镇痛效果更好,而且可以减少阿片类药物用量,降低不良反应的发生率,提高术后镇痛的安全性。Objective To compare the efficacy of parasternal pectoralis major intercostal muscle plane block and intercostal nerve block for postoperative analgesia after cardiac surgery in infants.Methods A total of 60 children aged 6 months to 3 years were randomly divided into two groups:the parasternal pectoralis major intercostal muscle plane block group(PPMIMP)and the intercostal nerve block group(ICNB),with 30 cases in each group.After anesthesia induction,the PPMIMP group received ultrasound-guided bilateral parasternal pectoralis major intercostal muscle plane block,and the ICNB group received ultrasound-guided bilateral intercostal nerve block.Both groups were routinely administered with sufentanil for nurse-controlled intravenous analgesia(NCIA).All children with FLACC pain behavior score≥5 after surgery were treated with tramadol injection for rescue analgesia.Record the sufentanil dosage,FLACC pain behavior score,Ramsay sedation score,the amount of rescue analgesia within 24 hours after operation,and the occurrence of adverse reactions such as nausea and vomiting,respiratory depression and excessive sedation at different time points in the two groups.record in the two groups whether there are complications of nerve block such as local anesthetic poisoning,pneumothorax and subcutaneous hematoma.Results There were no significant differences in sufentanil dosage,FLACC pain behavior score and Ramsay sedation score at 2 and 4h after the beginning of analgesia between the two groups(P>0.05).The sufentanil dosage at 8,12,18 and 24h after the beginning of analgesia in PPMIMP group was significantly lower than that in ICNB group(P<0.05).The pain behavior score of FLACC and Ramsay sedation score of PPMIMP group were significantly lower than those of ICNB group at 8,12 and 24h after the beginning of analgesia(P<0.05).The rate of rescue analgesia within 24 hours after surgery in PPMIMP group was significantly lower than that in ICNB group(P<0.05).The incidence of adverse reactions in PPMIMP group was significantly lower t

关 键 词：胸骨旁胸大肌肋间肌平面阻滞 肋间神经阻滞 婴幼儿心脏手术 术后镇痛 

分 类 号：R741[医药卫生—神经病学与精神病学]