脉冲式与连续竖脊肌平面阻滞用于胸腔镜肺癌根治术镇痛效果的比较  

Comparison of analgesia between intermittent bolus infusion and continuous infusion after erector spinae plane block for thoracoscopic radical resection of lung cancer

作　　者：彭捷 陈晓霞 吴友平 贾济 王昕辉 郄文斌 徐波 PENG Jie;CHEN Xiaoxia;WU Youping;JIA Ji;WANG Xinhui;QIE Wenbin;XU Bo(Department of Anesthesiology, the General Hospital of Southern Theatre Command, Guangzhou, Guangdong, 510010, China)

机构地区：[1]南部战区总医院麻醉科,广东广州510010

出　　处：《暨南大学学报（自然科学与医学版）》2022年第3期263-268,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：广东省自然科学基金项目(2021A1515010077);广州市科技计划项目(201804010060,202002030379);军队后勤科研项目(CLB21J023)。

摘　　要：目的:比较脉冲式与连续竖脊肌平面阻滞用于胸腔镜肺癌根治术的镇痛效果。方法:择期行单孔或两孔胸腔镜肺癌根治术患者72例,以随机数字表法分为脉冲式竖脊肌平面阻滞组(IESPB组)和恒速连续阻滞组(C组),每组36例。比较两组术后48 h内地佐辛补救镇痛用量,术后2、4、6、12、24、48 h静息及咳嗽疼痛数字评分(NRS),首次阻滞后9、18、31 h阻滞的皮区数目及切口对应肋间的机械痛阈值,术后24、48 h的QoR-15评分及头晕、恶心呕吐、皮肤瘙痒、便秘等不良反应情况。结果:纳入患者72例,最终63例完成研究(IESPB组32例,C组31例)。与C组比较,IESPB组术后48 h内地佐辛用量显著减少,术后4、6、12、24、48 h咳嗽NRS更低,首次阻滞后9、18、31 h阻滞皮区数更多,其两孔手术观察孔对应肋间的机械痛阈值更高,术后24及48 h的QoR-15评分更高,恶心呕吐发生率更低(P<0.05)。其余各指标及不良反应发生率无统计学差异(P>0.05)。结论:脉冲式竖脊肌平面阻滞用于胸腔镜肺癌根治术,术后阿片类药物需求更低,阻滞皮区更广,恢复质量高,镇痛效果较连续式阻滞相对更优。Objective:To compare the analgesic efficacy of intermittent bolus infusion and continuous infusion after erector spinae plane block(ESPB)for thoracoscopic radical resection of lung cancer.Methods:A total of 72 patients,scheduled for elective single-port or two-port thoracoscopic radical resection of lung cancer,were divided into 2 groups using a random number table method:intermittent bolus infusion group(IESPB group)and continuous infusion group(C group),with 36 patients each.The consumption of rescue dezocine within 48 h,NRS of resting and coughing at 2 h,4 h,6 h,12 h,24 h,48 h postoperatively,amount of anesthetized dermatomes at 9 h,18 h,31 h after initiation of ESPB and the mechanical pain threshold of intercostal incision,QoR-15 score at 24 h,48 h after surgery and adverse reactions such as dizziness,nausea and vomiting,skin itching and constipation were compared between the two groups.Results:Seventy-two patients were enrolled,and 63 completed the study,including 32 in IESPB group and 31 in C group.Compared with C group,less dosage of rescue dezocine within 48 h,lower NRS at 4 h,6 h,12 h,24 h and 48 h postoperatively,more anesthetized dermatomes at 9 h,18 h and 31 h after initiation of ESPB,higher mechanical pain threshold at intercostal incision of observation hole in two-port surgery,higher QoR-15 score at 24 h and 48 h after surgery,and lower incidence of nausea and vomiting were achieved in IESPB group(P<0.05).There were no significant differences in other indexes and incidence of adverse reactions between the two groups(P>0.05).Conclusion:The analgesic efficacies of intermittent bolus infusion may be superior to continuous infusion after ESPB for thoracoscopic radical resection of lung cancer,providing a less opioid consumption and a wider dermatomal spread of sensory blockade with enhanced recovery.

关 键 词：脉冲式输注 连续式输注 竖脊肌平面阻滞 胸腔镜肺癌根治术 镇痛 

分 类 号：R614.3[医药卫生—麻醉学]