右侧星状神经节-前锯肌平面阻滞联合全麻在胸腔镜下肺癌根治术中的效果  

Effect of right stellate ganglion block-serratus anterior plane block combined with general anesthesia in thoracoscopic radical resection of lung cancer

作　　者：贺争光 陈溪 徐霞 刘大为 孙晨旭 邓芳 冯飚 孙志华[2] He Zhengguang;Chen Xi;Xu Xia;Liu Dawei;Sun Chenxu;Deng Fang;Feng Biao;Sun Zhihua(Department of Anesthesiology,Xiangya Changde Hospital,Changde 415000,China;Department of Anesthesiology,XiangYa Hospital of Central South University,Changsha 410008,China)

机构地区：[1]湘雅常德医院麻醉科,常德415000 [2]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中国医师杂志》2023年第3期393-396,共4页Journal of Chinese Physician

基　　金：湖南省科技创新计划项目(2018JJ2659);常德市科技局科技创新发展项目(2020S114)。

摘　　要：目的评价右侧星状神经节-前锯肌平面阻滞联合全麻在胸腔镜下肺癌根治术的效果。方法前瞻性选取2020年3月至2021年9月湘雅常德医院90例拟行胸腔镜下肺癌根治术的患者,采用随机数字表法分为3组:全麻组(G组)、前锯肌平面阻滞(SAPB)+全麻组(SG组)、右侧星状神经节阻滞(RSGB)+SAPB+全麻组(RSG组),每组各30例。SG组于全麻前行术侧SAPB,RSG组于全麻前行RSGB+术侧SAPB,待阻滞效果确定后所有患者根据体重以相同方案实施全麻并于术后配置患者静脉自控镇痛(PCIA)。记录麻醉前(T_(0))、插管前(T_(1))、插管后1 min(T_(2))、插管后5 min(T_(3))、拔管时(T_(4))、拔管后5 min(T_(5))各时点平均动脉压(MAP)、心率(HR);记录术中瑞芬太尼用量;术后24 h内恶心呕吐(PONV)发生率;24 h内PCIA追加次数和术后24 h时静态、动态疼痛视觉模拟评分(VAS);术后24 h舒适度评分(BCS)和睡眠质量评分(RSCQ)。结果与T_(0)时相比,三组患者在插管后1 min(T_(2))、拔管时(T_(4))MAP、HR均升高,但RSG组升高幅度显著小于G组和SG组(均P<0.05);SG组和RSG组术中瑞芬太尼用量、PONV发生率、PCIA追加次数少于G组,BCS评分、RSCQ评分高于G组(均P<0.05),且RSG组BCS评分、RSCQ评分高于SG组(均P<0.05)。结论RSGB+SAPB联合全麻用于胸腔镜下肺癌根治术循环波动小,术后镇痛效果好,不良反应少且舒适度高。Objective To investigate the effect of right stellate ganglion block(RSGB)-serratus anterior plane block(SAPB)combined with general anesthesia in thoracoscopic radical resection of lung cancer.Methods A total of 90 patients who planned to undergo thoracoscopic radical resection of lung cancer in Xiangya Changde Hospital from March 2020 to September 2021 were prospectively selected and divided into 3 groups by random number table method:general anesthesia group(G group),(SAPB)+general anesthesia group(SG group),RSGB+SAPB+general anesthesia group(RSG group),30 cases in each group.The SG group received SAPB on the operative side before general anesthesia,and the RSG group received RSGB+SAPB on the operative side before general anesthesia.After the blocking effect was determined,all patients were given general anesthesia in the same scheme according to their weight,and patients were given patient-controlled intravenous analgesia(PCIA)after surgery.The mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia(T_(0)),before intubation(T_(1)),1 min after intubation(T_(2)),5 min after intubation(T_(3)),at extubation(T_(4))and 5 min after extubation(T_(5)).The intraoperative dosage of remifentanil,incidence of nausea and vomiting(PONV)within 24 hours after surgery,number of additional PCIA within 24 hours,the Visual Analogue Scale(VAS)of static and dynamic pain,the Bruggrmann Comfort Scale(BCS)and Richard Campbell Sleep Questionnaire(RSCQ)24 hours after surgery were recorded.Results Compared with T_(0),the MAP and HR in 3 groups were increased 1 min after intubation(T_(2))and at extubation(T_(4)),but the increases in RSG group were significantly less than those in G and SG groups(all P<0.05).The remifentanil dosage,PONV incidence and PCIA supplemental times in SG and RSG groups were less than those in G group,and the BCS score and RSCQ score were higher than those in G group(all P<0.05);the BCS score and RSCQ score in RSG group were higher than those in SG group(all P<0.05).Conclusions RSGB+SAPB combine

关 键 词：麻醉 全身 胸腔镜检查 肺肿瘤 神经传导阻滞 星状神经节 前锯肌 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]