超声引导前锯肌平面阻滞联合胸神经Ⅰ型阻滞在机器人辅助冠状动脉旁路移植术围术期镇痛中的应用  

Perioperative analgesic efficacy of ultrasound-guided serratus anterior plane block and pectoral nerve blockⅠin patients undergoing robot-assisted 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;Wang Gang;Yu Wenli(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院麻醉科,天津300192

出　　处：《中华解剖与临床杂志》2023年第3期172-177,共6页Chinese Journal of Anatomy and Clinics

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：目的探讨超声引导前锯肌平面阻滞(SAPB)联合胸神经(PECS)Ⅰ型阻滞对机器人辅助直视下冠状动脉旁路移植术(RADCAB)患者围术期镇痛的应用效果。方法前瞻性随机对照研究。纳入2020年2月—2022年4月天津市第一中心医院行择期RADCAB患者60例, 按数字表法随机分为对照组(C组)和SAPB联合PECS Ⅰ阻滞组(SP组), 每组30例。2组患者均采用全身麻醉和术后自控静脉镇痛(PCIA), SP组患者于麻醉诱导前行超声引导下SAPB联合PECS Ⅰ型阻滞。记录2组患者拔除气管插管后2 h(T_(1))、4 h(T_(2))、12 h(T_(3))和24 h(T_(4))静息状态及咳嗽时的疼痛视觉模拟评分法(VAS)评分, 比较术中及术后24 h内舒芬太尼用量、术后24 h内PCIA有效按压次数、首次补救镇痛时间、补救镇痛率、拔管时间、ICU停留时间和术后并发症发生情况。结果 C组术中转为开胸手术1例剔除观察。2组患者T_(4)静息状态和咳嗽时疼痛VAS评分的比较, 差异均无统计学意义(P值均>0.05)。SP组患者T_(1)~T_(3)静息状态疼痛VAS评分[(2.2±0.7)分、(2.7±0.5)分、(3.1±0.5)分]均低于C组[(4.0±0.6)分、(3.7±0.5)分、(3.7±0.5)分], 差异均有统计学意义(t=10.80、7.40、4.04, P值均<0.001);T_(1)~T_(3)咳嗽时疼痛VAS评分[(2.9±0.7)分、(3.4±0.6)分、(3.5±0.6)分]均低于C组[(5.1±0.4)分、(4.6±0.6)分、(4.1±0.5)分], 差异均有统计学意义(t=15.44、8.33、3.98, P值均<0.05)。SP组患者术中和术后24 h内舒芬太尼用量分别为(109±13)μg和(62±10)μg, 均低于C组[(146±21)μg和(72±10)μg], 差异均有统计学意义(t=8.01、3.74, P值均<0.001)。SP组患者术后24 h内PCIA有效按压次数为(4. 4±2.1)次, 低于C组的(8.4±1.9)次;首次补救镇痛时间为术后(18.2±3.1)h, 大于C组的(8.0±1.7)h;补救镇痛率为26.7%(8/30), 低于C组的82.8%(24/29):差异均有统计学意义(t=7.57、11.90, χ^(2)=18.70, P值均<0.001)。SP组患者拔管时间为术后(4.4±1.3)h, ICU停留时间为(44.7Objective This study aims to probe the perioperative analgesic efficacy of ultrasound-guided serratus anterior plane block(SAPB)and pectoral nerveⅠ(PECSⅠ)block in patients undergoing robot-assisted direct-vision coronary artery bypass(RADCAB).Methods A prospective randomized control trial was conducted.A total of 60 patients who were scheduled for selective RADCAB in the operation center of Tianjin First Central Hospital from February 2020 to April 2022 were included.All patients were randomly divided into the Control group(C group,n=30)and SAPB plus PECSⅠblock group(SP group,n=30).In addition,all patients were given general anesthesia and patient controlled intravenous analgesia(PCIA)postoperatively.Then,ultrasound-guided SAPB and PECSⅠblock were performed before anesthesia induction only in patients of the SP group.Visual analog scale(VAS)scores at different time points after extubation(2 h,T_(1);4 h,T_(2);12 h,T_(3);and 24 h,T_(4)),at rest and during coughing,were recorded separately.Meanwhile,intraoperative and 24 h postoperative sufentanil dosage,effective times of PCIA,first rescue analgesic time,ratio of rescue analgesia,extubation time,duration of ICU stay and incidence of postoperative complications were compared separately.Results One case of the C group was excluded for transferring to thoracotomy during the operation.There was no statistical difference found in the VAS score of T_(4),both at rest and during coughing(all P values>0.05).Resting VAS scores at T_(1)(2.2±0.7),T_(2)(2.7±0.5),and T_(3)(3.1±0.5)in the SP group were lower than those in the C group(4.0±0.6,3.7±0.5,and 3.7±0.5,respectively)with significant differences(t=10.80,7.40,and 4.04;all P values<0.001).Meanwhile,coughing VAS scores at T_(1)(2.9±0.7),T_(2)(3.4±0.6),and T_(3)(3.5±0.6)in the SP group were lower than those in the C group(5.1±0.4,4.6±0.6,and 4.1±0.5,respectively)with significant differences(t=15.44,8.33 and 3.98;all P values<0.001).However,in the SP group,the intraoperative sufentanil dosage([109±13]μg)an

关 键 词：神经传导阻滞 麻醉和镇痛 围术期镇痛 前锯肌平面阻滞 胸神经阻滞 机器人辅助冠状动脉旁路移植术 

分 类 号：R614[医药卫生—麻醉学]