胸骨旁胸大肌肋间肌平面阻滞对儿童心脏手术后康复质量的影响  

Effect of parasternal pectoralis major intercostal muscle plane block on the quality of recovery after pediatric cardiac surgery

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(Department of Anesthesiology,Guangdong Women and Children s Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院麻醉科,广东广州511442

出　　处：《麻醉安全与质控》2021年第5期266-270,共5页Perioperative Safety and Quality Assurance

基　　金：广州市科技计划项目(201904010460)。

摘　　要：目的探讨双侧胸骨旁胸大肌肋间肌平面(PPMIMP)阻滞对儿童心脏手术后康复质量的影响。方法选取我院2017-11/2019-12期间拟择期行室间隔缺损修补术或房间隔缺损修补术的5~9岁患儿60例,随机分为对照组(n=30)和阻滞组(n=30)。麻醉诱导后,阻滞组患儿在超声引导下行双侧PPMIMP阻滞,对照组未进行阻滞操作。两组患儿术后均常规使用舒芬太尼行患者自控静脉镇痛(PCIA)。术前1 d以及术后24、48、72 h由患儿陪护者填写恢复质量量表(QoR-15)。记录术后24 h、48 h舒芬太尼用量、术后机械通气时间、重症监护病房(ICU)滞留时间、术后住院时间、QoR-15评分以及术后48 h内恶心呕吐、呼吸抑制、过度镇静、镇痛不全等不良反应发生情况。结果术后舒芬太尼用量阻滞组明显低于对照组(P<0.05),阻滞组ICU滞留时间、术后住院时间明显短于对照组(P<0.05),2组术后机械通气时间差异无统计学意义(P>0.05),术后24、48、72 h阻滞组QoR-15评分均明显高于对照组(P<0.05),阻滞组不良反应发生率明显低于对照组(P<0.05)。结论PPMIMP阻滞可以促进开胸心脏手术患儿快速康复并提高康复质量。Objective To investigate the impact of bilateral parasternal pectoralis major intercostal muscle plane(PPMIMP)block on the quality of recovery after pediatric cardiac surgery.Methods A total of 60 children,aged 5-9 years,who planned to undergo ventricular septal defect repair or atrial septal defect repair from November 2017 to December 2019 in our hospital were randomly divided into the control group(n=30)and the block group(n=30).After anesthesia induction,the children in the block group underwent bilateral PPMIMP block guided by ultrasound,while the control group was not subjected to block operation.Children in both groups were routinely received sufentanil for patient-controlled intravenous analgesia(PCIA)after surgery.The quality of recovery scale(QoR-15)was filled by the child’s caregivers 1 day before surgery and 24 h,48 h and 72 h after surgery.The dosage of sufentanil 24 h and 48 h after surgery,postoperative mechanical ventilation time,intensive care unit(ICU)retention time,postoperative hospitalization time,QoR-15 score,and the incidence of adverse reactions such as nausea and vomiting,respiratory depression,excessive sedation,and analgesia insufficiency within 48 h after surgery were recorded.Results The postoperative dosage of sufentanil in block group was significantly less than that in control group(P<0.05).The ICU retention time and postoperative hospitalization time in the block group were significantly shorter than those in the control group(P<0.05).There was no statistically significant difference in postoperative mechanical ventilation time of two groups(P>0.05).The QoR-15 scores of the block group at 24 h,48 h and 72 h after surgery were significantly higher than those of the control group(P<0.05).The incidence of adverse reactions in block group was significantly lower than that in the control group(P<0.05).Conclusion PPMIMP block can promote the rapid recovery and improve the quality of recovery in children after pediatric cardiac surgery.

关 键 词：胸骨旁胸大肌肋间肌平面阻滞 儿童心脏手术 康复质量 

分 类 号：R726.1[医药卫生—儿科]