超声引导下胸神经Ⅱ型阻滞对机器人辅助直视下冠状动脉旁路移植术患者围手术期的镇痛效果  

Perioperative analgesic efficacy of ultrasound-guided pectoral nerve block Ⅱ in patients undergoing robot-assisted direct-vision coronary artery bypass

作　　者：任恒昌[1] 翁亦齐[1] 朱敏[1] 王刚[1] 喻文立[1] REN Hengchang;WENG Yiqi;ZHU Min(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192A,CHINA)

机构地区：[1]天津市第一中心医院麻醉科,300192

出　　处：《江苏医药》2023年第2期154-157,163,共5页Jiangsu Medical Journal

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-045A);天津市第一中心医院院级项目(院2020CF03)。

摘　　要：目的探讨超声引导下胸神经Ⅱ型阻滞用于机器人辅助直视下冠状动脉旁路移植术(RADCAB)患者围手术期的镇痛效果。方法将59例行择期RADCAB的冠心病患者随机分为胸神经Ⅱ型阻滞组(P组,30例)和对照组(C组,29例)。两组均采用全身麻醉,术后使用静脉患者自控镇痛;P组于麻醉诱导前行超声引导下胸神经Ⅱ型阻滞。记录拔管后2 h(T1)、4 h(T2)、12 h(T3)和24 h(T4)时静息和咳嗽状态下VAS疼痛评分。记录术中和术后24 h内舒芬太尼用量、术后24 h内镇痛泵有效按压次数、术后首次补救镇痛时间、术后24 h补救镇痛率、拔管时间、ICU停留时间以及术后并发症发生情况。结果P组T1~T3时静息和咳嗽状态下VAS疼痛评分均低于C组(P<0.05)。与C组相比,P组术中及术后24 h内舒芬太尼用量和镇痛泵有效按压次数减少,首次补救镇痛时间延长,拔管时间和ICU停留时间缩短,补救镇痛率以及术后恶心呕吐、皮肤瘙痒和肺不张发生率降低(P<0.05)。结论超声引导下胸神经Ⅱ型阻滞可为RADCAB患者提供安全、有效的围手术期镇痛,并减少阿片类药物用量和术后并发症发生。Objective To investigate the perioperative analgesic efficacy of ultrasound-guided pectoral nerve block Ⅱ in the patients undergoing robot-assisted direct-vision coronary artery bypass(RADCAB).Methods Fifty-nine patients with coronary heart disease undergoing selective RADCAB were randomly divided into two groups of P(with pectoral nerve blockⅡ,30 cases)and C(control group,29 cases).All the patients were given general anesthesia and intravenous patient-controlled analgesia(PCA)after operation.The pectoral nerve block Ⅱ was performed before anesthesia induction in group P.The VAS pain scores were recorded in the 2^(nd)(T1),4^(th)(T2),12^(th)(T3)and 24^(th)hour(T4)after extubation in resting and coughing states.The consumption of sufentanil during operation and within 24 hours after operation,effective pressing times of intravenous PCA within 24 hours after operation,the first time of rescuing analgesia after operation,rate of rescuing analgesia within 24 hours after operation,extubation time,duration of ICU stay and incidence of postoperative complications were recorded.Results The VAS pain scores at T1-T3 in resting and coughing states in group P were lower than those in group C(P<0.05).Compared with group C,the consumption of sufentanil during operation and within 24 hours after operation and effective pressing times of intravenous PCA were decreased,the first time of rescuing analgesia was prolonged,the extubation time and duration of ICU stay were shortened,and the rate of rescuing analgesia and incidences of nausea and vomiting,cutaneous pruritus and pulmonary atelectasis after operation were decreased in group P(P<0.05).Conclusion Ultrasound-guided pectoral nerve block Ⅱ can provide a safe and effective perioperative analgesia in the patients undergoing RADCAB with decreased opioids use and complications.

关 键 词：围手术期镇痛 胸神经阻滞 机器人辅助直视下冠状动脉旁路移植术 

分 类 号：R614[医药卫生—麻醉学]