胸横肌平面阻滞联合星状神经节阻滞在心肺转流下二尖瓣置换手术中的应用效果分析  

Effect of transverse thoracic muscle plane block combined with stellate ganglion block in mitral valve replacement under cardiopulmonary bypass

作　　者：侯天亮[1] 李瑾[1] 李帆[1] 艾来提·塔来提[1] Hou Tianliang;Li Jin;Li Fan;Ailaiti Talaiti(Department of Anesthesiology,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumchi 830054,China)

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《中国体外循环杂志》2022年第2期97-102,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 探究胸横肌平面(TTMP)阻滞和星状神经节阻滞(SGB)联合应用在二尖瓣置换术中的应用效果。方法 选取2018年1月至2019年12月在本院择期行二尖瓣置换手术的患者120名。采用计算机随机软件将患者分为四组:对照组(A组)、TTMP组(B组)、SGB组(C组)和TTMP+SGB组(D组)。四组患者于麻醉诱导前(T0)、麻醉诱导后(T1)、气管插管后(T2)、劈胸骨后(T3)、开始心肺转流(CPB)时(T4)和CPB结束时(T5)记录心率和平均动脉压,于麻醉诱导前(T0)、术后3 h(T6)、12 h(T7)、24 h(T8)测定患者血中白介素(IL)-6、肿瘤坏死因子(TNF)-α、心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CKMB)含量,记录患者术中阿片类药物使用量及术后恢复情况。结果 与A组相比,D组患者的血流动力学最为平稳(P<0.05);四组患者基础cTnI、CKMB、IL-6和TNF-α的含量在T0时点均无统计学差异,随后呈逐渐升高趋势。与A组患者相比,C组和D组患者血中cTnI和CKMB T6~T8的含量均降低(P<0.05),而B组和D组患者血中IL-6和TNF-αT6~T8的含量均降低(P<0.05);与A组相比,B组、C组、D组的舒芬太尼用量减少(P<0.05);苏醒时间、机械通气时间和ICU滞留时间也都相应缩短。结论 经正中切口心肺转流下行二尖瓣置换手术中联合应用TTMP和SGB阻滞具有协同心肌保护的作用。Objective To explore the effect of combined application of transverse thoracic muscle plane block(TTMP) and stellate ganglion block(SGB) in mitral valve replacement. Methods 120 patients who underwent mitral valve replacement in our hospital from January 2018 to December 2019 were selected. The patients were randomly divided into four groups: control group(group A), TTMP group(group B), SGB group(Group C) and TTMP + SGB group(Group D). HR and MAP were recorded before anesthesia induction(T0), after anesthesia induction(T1), after endotracheal intubation(T2), after sternotomy(T3), at the beginning of CPB(T4) and at the end of CPB(T5). The levels of IL-6, TNF-α, cTnI and CKMB in blood were measured before anesthesia induction(T0), 3 h(T6), 12 h(T7) and 24 h(T8) after the operation, and the intraoperative opioid use and postoperative recovery were recorded. Results Compared with group A, group D had the most stable hemodynamics(P<0.05);The contents of basic cTnI, CKMB, IL-6 and TNF-α in the four groups had no significant difference at T0, and then increased gradually. Compared with group A, the levels of cTnI and CKMB(T6-T8) in group C and D were decreased(P<0.05), and the levels of IL-6 and TNF-α(T6-T8) in group B and D were decreased(P<0.05);Compared with group A, the dosage of sufentanil in group B, group C and group D were decreased(P<0.05), and the recovery time, mechanical ventilation time and ICU stay time were shortened accordingly. Conclusion The combined application of TTMP and SGB block in mitral valve replacement through median incision has synergistic myocardial protective effects.

关 键 词：心肺转流 心脏手术 胸横肌平面阻滞 星状神经节阻滞 心肌保护 

分 类 号：R614[医药卫生—麻醉学]