前锯肌平面阻滞与胸椎旁神经阻滞对胸腔镜手术患者术后镇痛效果及炎症反应的影响  

Influence of serratus anterior plane block and thoracic paravertebral nerve block on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic surgery

作　　者：闵鑫 周仕彬 樊雅玲[1] MIN Xin;ZHOU Shi-bin;FAN Ya-ling(Department of Anesthesiology,Leshan People's Hospital,Leshan Sichuan 614000,China)

机构地区：[1]乐山市人民医院麻醉科,四川乐山614000

出　　处：《临床和实验医学杂志》2021年第13期1415-1419,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省医学会课题项目(编号:2019TG06)。

摘　　要：目的对比观察前锯肌平面阻滞与胸椎旁神经阻滞对胸腔镜手术患者术后镇痛效果及炎症反应的影响。方法前瞻性选取2019年3月至2020年6月期间乐山市人民医院收治并行胸腔镜下肺段或肺叶切除手术的80例患者作为研究对象,采用单双数标记法随机分为前锯肌平面阻滞(SAPB)组和胸椎旁神经阻滞(TPVB)组各40例。SAPB组患者经支气管插管静脉全身麻醉后行前锯肌平面阻滞,TPVB组患者经支气管插管静脉全身麻醉后行胸椎旁神经阻滞,术后均给予罗哌卡因罗哌卡因,拔管后均口服洛芬待因缓释片镇痛。记录并比较2组患者的镇痛药物使用情况、不同时点镇痛效果、炎症因子变化和并发症发生情况。结果SAPB组患者术中舒芬太尼使用量为(106.43±5.80)μg,显著少于TPVB组[(111.29±5.46)μg],首次按压PCIA时间为(12.84±2.75)h、显著晚于TPVB组[(10.22±1.48)h],差异均有统计学意义(P<0.05)。术后12 h,SAPB组患者静息和咳嗽状态下的VAS评分为(1.73±0.43)、(2.14±0.75)分,均显著低于同状态下的TPVB组[(2.89±0.64)、(2.95±0.93)分],差异均有统计学意义(P<0.05)。术后48 h,2组患者血清白细胞介素(IL)-6、IL-10水平均显著上升,但SAPB组血清IL-6、IL-10水平[(82.69±2.40)、(139.25±6.32)ng/L]显著低于TPVB组[(96.56±2.48)、(177.65±4.35)ng/L],差异均有统计学意义(P<0.05)。术后48 h,SAPB组患者术后不良反应发生率(17.5%)与TPVB组(20.0%)比较,差异均无统计学意义(P>0.05)。结论SAPB与TPVB均可减轻胸腔镜手术患者疼痛和炎症反应,但SAPB镇痛起效更快,术中对阿片类药物的使用量更少,预后所引起的不良反应也相对更少。Objective To explore the effects of serratus anterior plane block(SAPB)and thoracic paravertebral block(TPVB)on postoperative analgesia and inflammatory response in patients undergoing thoracoscopic surgery.Methods From March 2019 to June 2020,80 patients with concurrent thoracoscopic lung or lobbectomy who were admitted to Leshan People's Hospital with thoracoscopy were prospectively selected as the research objects,and they were randomly divided into SAPB group and TPVB group using odd and even number marking method,40 cases in each group.Patients in the SAPB group underwent general anesthesia via bronchial intubation and received serratus anterior plane block.Patients in the TPVB group underwent general anesthesia via bronchial intubation and received thoracic paraspinal nerve block.All patients were given ropivacaine after operation.After extubation,profenbeine sustained-release tablets were taken orally for analgesia.The surgical indicators,the use of analgesics,analgesic effects,inflammatory reactions and complications were recorded in the two groups.Results The intraoperative use of sufentanil in the SAPB group was(106.43±5.80)μg,which significantly less than that in the TPVB group[(111.29±5.46)μg],and the first PCIA compression time was(12.84±2.75)h,which was significantly later than in the TPVB group[(10.22±1.48)h],the differences were statistically significant(P<0.05).At 12 h after surgery,the VAS scores of patients in the SAPB group at rest and cough were(1.73±0.43)and(2.14±0.75)points,which were significantly lower than those in the TPVB group under the same state[(2.89±0.64),(2.95±0.93)points],the differences were statistically significant(P<0.05).At 48 hours after operation,the levels of serum IL-6 and IL-10 of the two groups increased significantly,but the levels of the above indicators in the SAPB group[(82.69±2.40),(139.25±6.32)ng/L]were still significantly lower than those in the TPVB group[(96.56±2.48),(177.65±4.35)ng/L],the differences were statistically significant(P<0.05).At 48

关 键 词：胸腔镜手术 前锯肌平面阻滞 胸椎旁神经阻滞 镇痛效果 炎症反应 

分 类 号：R614[医药卫生—麻醉学]