双侧胸横肌平面阻滞对心脏外科手术患儿术后快速康复的影响  

Effect of bilateral transversus thoracis muscle plane block on fast track recovery after pediatric cardiac surgery

作　　者：李晴晴 方印 张斯璧 魏国华 尤纱纱 LI Qing-qing;FANG Yin;ZHANG Si-bi;WEI Guo-hua;YOU Sha-sha(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏南京210029

出　　处：《中国当代医药》2021年第31期125-128,共4页China Modern Medicine

摘　　要：目的探讨超声引导下双侧胸横肌平面(TTP)阻滞对减轻心脏外科手术患儿术后疼痛的有效性和安全性。方法选择2020年1月至2020年12月于南京医科大学第一附属医院择期行胸骨正中切口室缺修补术的50例患儿,采用随机数字表法将其分为TTP组和对照组,每组各25例。TTP组患儿手术后在超声引导下平面内进针技术将0.375%罗哌卡因注射在双侧肋间内肌和胸横肌之间的平面,对照组不进行神经阻滞。比较两组术后改良目的疼痛评分(MOPS)、术中和术后24 h芬太尼用量、术后机械通气时间、ICU停留时间及住院时间,观察TTP阻滞相关不良事件的发生情况。结果TTP组术后6、8、12、24 h的MOPS低于对照组,差异有统计学意义(P<0.05);TTP组术后48 h的MOPS高于本组术后6 h,差异有统计学意义(P<0.05)。TTP组术后24 h芬太尼用量少于对照组,TTP组术后机械通气时间、ICU停留时间短于对照组,差异有统计学意义(P<0.05)。两组术中芬太尼用量以及住院时间比较,差异无统计学意义(P>0.05)。TTP组未出现TTP阻滞相关不良事件。结论超声引导下双侧TTP阻滞可安全有效地应用于心脏外科手术患儿术后镇痛,促进患儿术后快速康复。Objective To explore the efficacy and safety of ultrasound bilateral thoracic transverse muscle plane(TTP)block on reducing postoperative pain in children with cardiac surgery.Methods A total of fifty pediatric patients in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020,and divided into the control group and the TTP group according to the random number table method,with 25 cases in each group.The TTP group received bilateral TTP blocks with 2.5 ml/kg 0.375%Ropivacaine,and the control group received no nerve block.The modified objective pain score(MOPS)in postoperative,the dose of Fentanyl used in interoperatively and postoperative 24 hours,the mechanical ventilation time in postoperative,the ICU stay time,and the length of stay were compared between the two groups,and observed the occurrence of adverse events related with TTP arrest.Results The MOPS of the TTP group was lower than of the control group in postoperative 6,8,12,24 hours,the difference was statistically significant(P<0.05).The MOPS of the TTP group in postoperative 24 hours was higher than that in postoperative 6 hours in the group,with statistically significant difference(P<0.05).The dose of Fentanyl used of the TTP group was less than that of the control group in postoperative 24 hours,the mechanical ventilation time in postoperative and the ICU stay time of the TTP group were shorter than those of the control group,with statistically significant differences(P<0.05).There were no statistically significant differences in the dose of Fentanyl used in interoperatively and the length of stay between the two groups(P>0.05).None of the children of the TTP group had any adverse events due to TTP block.Conclusion Ultrasound guided bilateral TTP block can be effectively and safely applied to postoperative analgesia in pediatric cardiac surgery,and promote rapid postoperative recovery.

关 键 词：胸横肌平面阻滞 改良目的疼痛评分 小儿心脏外科 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]