超声引导双侧竖脊肌平面神经阻滞对小儿Nuss术后疼痛及睡眠质量的影响  

Effects of ultrasound-guided bilateral erector spinal plane nerve block on postoperative pain and sleep quality in children with pectus excavatum undergoing Nuss

作　　者：朱义[1] 邝日裕[1] 汤可香[1] 陈政[1] Zhu Yi;Kuang Riyu;Tang Kexiang;Chen Zheng(Department of Anesthesia and Surgery,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院麻醉手术科,长沙410007

出　　处：《中国医师杂志》2022年第12期1823-1827,共5页Journal of Chinese Physician

基　　金：湖南省卫生健康委科研计划(20200802);湖南省自然科学基金(2019JJ50295)。

摘　　要：目的探讨超声引导竖脊肌平面神经阻滞对小儿漏斗胸Nuss矫治围手术期疼痛及睡眠质量的影响。方法前瞻性选取2020年2月至2021年12月湖南省儿童医院40例择期行Nuss术的漏斗胸患儿,采用随机数字表法随机分为竖脊肌平面阻滞复合全麻组(E组)和全麻对照组(G组),每组20例。E组全麻后超声引导下行双侧竖脊肌平面神经阻滞,G组常规行气管插管全身麻醉。记录术后2、6、12、24、48 h视觉模拟疼痛量表(VAS)评分;两组患儿术中舒芬太尼追加情况,麻醉复苏室(PACU)拔管时间及离室时间;镇痛泵有效按压次数及补救镇痛例数。使用匹兹堡睡眠质量指数(PSQI)对患儿手术前和手术后2 d的睡眠质量进行评分。记录拔管后低氧血症、躁动、恶心呕吐发生情况,记录有无气胸、局麻药中毒等并发症发生。结果E组术后2、6、12、24 h VAS疼痛评分低于G组(均P<0.05)。两组术后48 h VAS疼痛评分差异无统计学意义(P>0.05)。E组PACU拔管及恢复时间短于G组(P均<0.05),与G组相比,E组术中追加舒芬太尼例数,镇痛泵按压次数和术后补救镇痛例数均少于G组(均P<0.05)。E组术后2 d睡眠质量指数PSQI评分优于G组(P<0.05)。E组术后低氧血症、躁动及恶心呕吐发生率低于G组(均P<0.05)。结论超声引导下双侧竖脊肌平面神经阻滞可有效减轻漏斗胸患儿Nuss术后疼痛,减少术后并发症及术中舒芬太尼使用量,改善术后睡眠质量,利于患儿恢复,值得推广。Objective To investigate the effects of ultrasound-guided bilateral erector spinal plane nerve block on postoperative pain and sleep quality in children with pectus excavatum undergoing Nuss.Methods From February 2020 to December 2021,40 children with pectus excavatum undergoing Nuss from Hunan Children′s Hospital were prospectively selected and randomly divided into two groups:group E(group E)with erector spinal muscle plane block combined with general anesthesia and group G(group G),with 20 patients in each group.After general anesthesia,ultrasound guided plane nerve block of bilateral erector spinal muscles was performed in group E,and general anesthesia with tracheal intubation was performed in group G.The Visual Analogue Scale(VAS)Score were recorded at 2,6,12,24 and 48 hours after surgery;The addition of sufentanil,the time of extubation of post anesthesia recovery room(PACU)and the time of leaving the PACU in each group were recorded;The effective pressure times of analgesic pump and the number of people for remedial analgesia were recorded.Pittsburgh sleep quality index(PSQI)was used to score the sleep quality of children before and 2 days after surgery.The occurrence of hypoxemia and restlessness after extubation,nausea and vomiting,pneumothorax,local anesthetic poisoning and other complications were recorded.Results The VAS score of group E at 2,6,12 and 24 hours after operation was lower than that of group G(all P<0.05).There was no significant difference in VAS score 48 hours after operation between the two groups(P>0.05).The time of decannulation and recovery of PACU in group E was shorter than that in group G(all P<0.05).Compared with group G,there were fewer cases of sufentanil added in group E during operation,and the number of analgesia pump pressing times and cases of postoperative remedial analgesia in group E were less than those in group G(all P<0.05).The PSQI score of sleep quality index 2 days after operation in group E was better than that in group G(P<0.05).The incidence of hypoxemia,re

关 键 词：超声检查 神经传导阻滞 胸外科手术 漏斗胸 疼痛 睡眠质量 

分 类 号：R726.1[医药卫生—儿科]