超声引导下竖脊肌平面阻滞对多发性肋骨骨折非手术患者呼吸功能和镇痛效果的影响  

Effect of ultrasound-guided erector spinae plane block on respiratory function and analgesia in non￣operative patients with multiple rib fractures

作　　者：任志强 梁文波 范国祥 秦卫民 张晓静 尹宁 REN Zhiqiang;LIANG Wenbo;FAN Guoxiang;QIN Weimin;ZHANG Xiaojing;YIN Ning(Department of Anesthesiology,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]南京医科大学附属逸夫医院麻醉科,211100

出　　处：《临床麻醉学杂志》2021年第11期1168-1171,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨竖脊肌平面阻滞(ESPB)对多发性肋骨骨折非手术患者呼吸功能和镇痛效果的影响。方法选择2018年5月至2019年11月创伤性多发性肋骨骨折非手术患者81例,男48例,女33例,年龄40~70岁,BMI<35 kg/m^(2),ASAⅠ或Ⅱ级。按照是否行ESPB将患者分为两组,ESPB组(E组,n=39)和非ESPB组(N组,n=42)。E组于入院当日或次日在超声引导下行ESPB,N组未行任何神经阻滞,仅给予胸带外固定及静脉滴注地佐辛5 mg。记录入院后24、48和72 h的用力肺活量(FVC)和VAS疼痛评分,记录入院后24 h内、入院后24~48 h和48~72 h时段内地佐辛用量。记录气胸、神经损伤、血肿、穿刺部位感染等并发症发生情况。结果与入院后24 h比较,入院后48和72 h E组FVC明显升高(P<0.05),VAS疼痛评分明显降低(P<0.05)。入院后48和72 h E组FVC明显高于N组(P<0.05),VAS疼痛评分明显低于N组(P<0.05)。与入院后24 h内比较,入院后24~48 h和48~72 h E组地佐辛用量明显减少(P<0.05)。入院后24~48 h和48~72 h E组地佐辛用量明显少于N组(P<0.05)。E组未出现气胸、神经损伤、血肿、穿刺部位感染等并发症。结论超声引导下ESPB能改善肋骨骨折非手术患者肺活量,提高镇痛效果,临床应用安全有效。Objective To explore effects of erector spinae plane block(ESPB)on the improvement of respiratory function and analgesia in nonoperative patients with multiple rib fractures.Methods Eighty-one non-operative patients,48 males and 33 females,aged 40-70 years,with a BMI<35 kg/m^(2),falling into ASA physical statusⅠorⅡ,with traumatic multiple rib fractures from May 2018 to November 2019 were selected.The patients were divided into two groups according to whether they underwent ESPB or not:ESPB group(group E,n=39)and non-ESPB group(group N,n=42).Patients in group E received ultrasound guided ESPB on the admission or the following day.Those in group N received external thoracic band fixation and intravenous drip of dezocine 5 mg instead.Forced vital capacity(FVC)and the VAS pain score were recorded 24,48,and 72 hours after admission,and the dezocine dosage were recorded at 24 hours,24-48 hours,and 48-72 hours after admission.Pneumothorax,nerve injury,hematoma,puncture site infection and other complications were recorded.Results Compared with 24 hours after admission,FVC in group E was significantly increased,and the VAS pain score in group E was significantly decreased 48 and 72 hours after admission(P<0.05).FVC in group E was significantly higher,and the value of VAS pain score in group E was significantly lower than that in group N 48 and 72 hours after admission(P<0.05).Compared with 24 hours after admission,the dosage of dezocine in group E was significantly decreased 24-48 hours and 48-72 hours after admission(P<0.05).The dosage of dezocine in group E was significantly lower than that in group N 24-48 hours and 48-72 hours after admission(P<0.05).Besides,There were no complications such as pneumothorax,nerve injury,haematoma or puncture site infection in group E.Conclusion The ultrasound-guided ESPB technique has benefits of improving pulmonary capacity and enhancing analgesic in non-operative rib fracture patients,and is safe and effective in clinical application.

关 键 词：超声引导 多发性肋骨骨折 竖脊肌平面阻滞 用力肺活量 视觉模拟疼痛评分 

分 类 号：R614[医药卫生—麻醉学]