超声引导下双侧竖脊肌平面阻滞联合自控镇痛泵用于儿童漏斗胸Nuss术的效果  

Efficacy of Ultrasound-guided Bilateral Erector Spinal Plane Block Combined with Patient-controlled Analgesia Pump for Pediatric Pa-tients Undergoing Nuss Procedure

作　　者：马阳巍 滑蕾 任艺 郑铁华[1] 许增华 高佳[1] 张富洲[1] 张建敏[1] MA Yangwei;HUA Lei;REN Yi(Department of Anesthesiology,Beijing Children′s Hospital,Capital Medical University,National Children′s Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《医学研究杂志》2023年第5期111-114,共4页Journal of Medical Research

基　　金：吴阶平医学基金会临床科研专项基金资助项目(320.6750.19089-102)。

摘　　要：目的探讨超声引导下双侧竖脊肌平面阻滞(erector spinae plane block,ESPB)联合自控镇痛泵应用于儿童漏斗胸Nuss术的效果。方法纳入择期行漏斗胸Nuss手术的患儿70例,患儿年龄4~18岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法分为竖脊肌平面阻滞+全麻组(E组)和单纯全麻组(G组),每组35例。两组患儿均采用相同的麻醉诱导方案,E组麻醉诱导后在超声引导下行双侧ESPB,术后均应用自控镇痛(patient-controlled analgesia,PCA)泵。记录患儿术后1、12、24及48h的疼痛评分,术中丙泊酚及瑞芬太尼用药情况,手术开始时血流动力学变化情况、术后镇痛情况(患儿PCA泵按压次数、镇痛泵总用药量)以及术后恶心、呕吐等不良反应发生情况。结果与G组比较,E组术中瑞芬太尼用量减少,术后12h内疼痛评分降低,术后1~12h及12~24h内PCA泵按压次数及自控静脉镇痛泵总用药量减少(P<0.05),术中丙泊酚用量、血流动力学变化情况、恶心及呕吐发生率等比较,差异无统计学意义(P>0.05)。结论超声引导双侧竖脊肌平面阻滞联合自控镇痛泵应用于儿童Nuss术具有良好镇痛效果,可以减少全身麻醉静脉药物用量和术后镇痛药物用量。Objective To investigate the effect of ultrasound-guided bilateral erector spinal plane block(ESPB)in combination with patient-controlled analgesia pump for pediatric patients undergoing Nuss procedure.Methods Seventy ASA gradeⅠ-Ⅱpatients,aged 4-18 years,undergoing Nuss procedure with general anethesia,were divided into two groups(n=35)by the random number table:erector spinal plane block with general anesthesia group(group E)and general anesthesia group(group G).Both groups received the same anesthesia induction program.Group E received bilateral ESPB after anesthesia induction,and patient-controlled analgesia pump was applied after surgery.Pain scores at 1,12,24 and 48h after surgery,intraoperative use of propofol and remifentanil,hemodynamic changes at the beginning of surgery,postoperative analgesia[number of patient-controlled analgesia(PCA)pump compressions,total analgesic pump dosing],postoperative nausea and vomiting,and other adverse reactions were recorded.Results Compared with group G,group E showed a decrease in intraoperative remifentanil dosage,pain scores within 12h postoperatively,the number of PCA pump compressions between 1-12h and 12-24h postoperatively,and the total dosage of analgesic pumps(P<0.05);while no significant differences were observed in intraoperative propofol dosage,hemodynamic changes,and the incidence of nausea and vomiting(P>0.05).Conclusion The combination of ultrasound-guided bilateral ESPB and patient-controlled analgesia pump has good analgesic effect in pediatric Nuss procedure,and can reduce the dosage of general anesthetic intravenous drugs and postoperative analgesic drugs.

关 键 词：漏斗胸 NUSS手术 竖脊肌平面阻滞 自控镇痛泵 

分 类 号：R614[医药卫生—麻醉学]