超声引导竖脊肌阻滞在开胸手术中的临床应用  

Clinical application of ultrasound guided vertical spinal muscle block in thoracotomy

作　　者：韦惠[1] 谭新梅 蓝英年[1] WEI Hui;TAN Xinmei;LAN Yingnian(Department of Anesthesiology,Hechi People′s Hospital,Hechi Guangxi 547000,China)

机构地区：[1]河池市人民医院麻醉科,广西河池547000

出　　处：《中国急救复苏与灾害医学杂志》2023年第9期1206-1210,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：广西河池市科学研究与技术开发计划项目(编号:B1824-10)。

摘　　要：目的分析超声引导下开展竖脊肌阻滞麻醉对于开胸手术的作用。方法选择80例开胸手术患者,随机数字表分组,治疗组40例采取超声引导下的竖脊肌阻滞麻醉联合静脉麻醉,对照组40例采取全凭静脉麻醉,对比麻醉效果。结果两组患者在入室时(T_(0))对比平均动脉压(MAP)与心率(heart rate,HR)水平差异无统计学意义(P>0.05)。治疗组在切皮时(T_(1))、单肺通气时(T_(2))、肋骨撑开即刻(T_(3))、缝皮时(T4)的MAP与HR指标均低于对照组,差异具有统计学意义(P<0.05)。治疗组的组间的康复指标均短于对照组,差异具有统计学意义(P<0.05)。术后不同时间点,治疗组在静息与咳嗽状态下的疼痛评分均低于对照组,治疗组的呼吸频率(RR)高于对照组,差异具有统计学意义(P<0.05)。治疗组的血氧饱和度(SpO_(2))水平接近于对照组(P>0.05)。术前,对比组间的炎性介质水平差异无统计学意义(P>0.05)。术后24 h,治疗组的炎性介质水平优于对照组,差异具有统计学意义(P<0.05)。结论超声引导下开展竖脊肌阻滞麻醉可以稳定患者体征,缩短术后康复时间,且能缓解术后痛感,减轻机体炎性反应。Objective The effect of ultrasound-guided anesthesia for erector spinal muscle block on thoracotomy was analyzed.Methods Eighty patients with thoracotomy surgery were selected and grouped in random numbers.In treatment group,40 patients received ultrasound-guided erector spinal block anesthesia combined with intravenous anesthesia,and 40 patients in control group received all-intravenous anesthesia to compare the anesthesia effect.Results There was no difference in mean arterial pressure(MAP)and heart rate(HR)levels at home entry(T_(0))(P>0.05).The MAP and HR measures in the treatment group(T_(1)),single lung ventilation(T_(2)),rib opening immediate(T_(3)),and suture(T4)were lower than those of the control group,and the difference was statistically significant(P<0.05).All the treatment groups were shorter than the control group,and the difference was statistically significant(P<0.05).At different time points,the pain score was lower than the control group,and the respiratory rate(RR)was higher than the control group,and the difference was statistically significant(P<0.05).The SpO_(2)level in the treatment group was close to that in the control group(P>0.05).Before surgery,there was no difference in inflammatory mediator levels between the comparison groups(P>0.05).At 24 hours after surgery,the level of inflammatory mediators in the treated group was better than that in the control group,which was statistically significant(P<0.05).Conclusion Ultrasound-guided erector spinal muscle block anesthesia can stabilize the patient′s physical signs,shorten the postoperative rehabilitation time,relieve the postoperative pain,and reduce the inflammatory reaction of the body.

关 键 词：超声引导 竖脊肌阻滞 开胸手术 疼痛评分 炎性介质 麻醉效果 

分 类 号：R614[医药卫生—麻醉学]