超声引导下前锯肌平面阻滞联合中心静脉导管引流在肺癌围术期快速康复中的应用  

Application of ultrasound guided serratus anterior plane block combined with central venous catheter drainage in ERAS during lung cancer perioperative period

作　　者：成强 杨如松 曹彬[1] 施庆彤[2] CHENG Qiang;YANG Rusong;CAO Bin;SHI Qingtong(Department of Thoracic Surgery,Affiliated Drum Tower Hospital,Nanjing University Medical College,Nanjing,Jiangsu 210008,China;Department of Thoracic Surgery,Affiliated Hospital of Yangzhou University,Yangzhou,Jiangsu 225003,China)

机构地区：[1]南京大学医学院附属鼓楼医院胸外科,210008 [2]扬州大学附属医院胸外科,225003

出　　处：《重庆医学》2022年第14期2459-2463,共5页Chongqing medicine

摘　　要：目的探讨超声引导下前锯肌平面阻滞联合中心静脉导管引流在肺癌围术期快速康复中的应用价值。方法选择2020年3月至2021年3月南京大学医学院附属鼓楼医院收治的180例行单操作孔肺癌根治术的患者。按照是否行超声引导下前锯肌平面阻滞和是否增加中心静脉导管引流分为4组,每组45例。A组行超声引导下前锯肌平面阻滞和增加中心静脉导管引流;B组仅增加中心静脉导管引流;C组仅行超声引导下前锯肌平面阻滞;D组既不行超声引导下前锯肌平面阻滞,也不增加中心静脉导管引流。观察4组患者术后疼痛情况,血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,下床时间、肛门首次排气时间、拔管时间及住院时间。结果A组与B组比较,术后24、72 h血清CRP、IL-6、TNF-α水平明显降低,下床时间、肛门首次排气时间、拔管时间和住院时间明显缩短,术后12、24 h疼痛明显减轻,差异有统计学意义(P<0.05)。A组与C组比较,术后72 h血清CRP、IL-6、TNF-α水平明显降低,疼痛明显减轻,拔管时间和住院时间明显缩短,差异有统计学意义(P<0.05)。B组与D组比较,术后72 h血清CRP、IL-6、TNF-α水平明显降低,拔管时间和住院时间明显缩短,术后72 h疼痛明显减轻,差异有统计学意义(P<0.05)。C组与D组比较,术后24、72 h的血清CRP、IL-6、TNF-α水平明显降低,术后12、24 h疼痛明显减轻,下床时间、肛门首次排气时间、拔管时间、住院时间均缩短,差异有统计学意义(P<0.05)。结论超声引导下前锯肌平面阻滞联合中心静脉导管引流可减轻术后疼痛,缩短下床时间、肛门首次排气时间、拔管时间和住院时间,促进患者术后快速康复。Objective To explore the application value of ultrasound-guided serratus anterior block combined with central venous catheter drainage in the enhanced recovery after surgery(ERAS)during the perioperative period in the patients with lung cancer.Methods A total of 180 patients with single-port radical resection of lung cancer treated in Affiliated Drum Tower Hospital of Nanjing University Medical College from March 2020 to March 2021were selected and divided into four groups according to whether conducting ultrasound guided serratus anterior plane blocked and whether adding the central venous catheter drainage,45 cases in each group.The group A underwent the ultrasound-guided serratus anterior plane block and added the central venous catheter drainage;the group B only added the central venous catheter drainage;the group C only conducted the ultrasound-guided serratus anterior plane block;the group D neither conducted the ultrasound-guided serratus anterior plane block and nor added the central venous catheter drainage.The postoperative pain,levels of serum C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),time for getting out of bed,time for first anal exhausting,extubation time and hospitalization time were observed in 4 groups.Results Compared with group B,the levels of CRP,IL-6 and TNF-αat postoperative 24,72 h in the group A were significantly reduced,the time for getting out of bed,anal exhausting time,extubation time and hospitalization duration were significantly shortened,the pain at postoperative 12,24 h was significantly relieved,and the differences were statistically significant(P<0.05).Compared with the group C,the levels of CRP,IL-6 and TNF-αat postoperative 72 h in the group A were significantly decreased,the pain was significantly relieved,the extubation time and hospitalization duration were significantly shortened,and the differences were statistically significant(P<0.05).Compared with the group D,the levels of CRP,IL-6 and TNF-αat postoperative 72 h in the group B

关 键 词：肺癌 中心静脉导管 前锯肌平面阻滞 快速康复 

分 类 号：R655.3[医药卫生—外科学]