胸椎旁神经阻滞联合竖脊肌平面阻滞对术后镇痛效果的影响  

Effect of Thoracic Paravertebral Nerve Block Combined with Erector Spinal Plane Block on Postoperative Analgesia.

作　　者：何坤鹏 崔翔 任凯[1] 范俊柏[2] He Kunpeng;Cui Xiang;Ren Kai(College of Anesthesia,Shanxi Medical University,Taiyuan,Shanxi 030001,China.)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]山西医科大学第二医院麻醉科,山西太原030001

出　　处：《四川医学》2023年第8期841-846,共6页Sichuan Medical Journal

摘　　要：目的术前超声引导下胸椎旁神经阻滞(TPVB)联合竖脊肌平面阻滞(ESPB)对双孔胸腔镜手术术后镇痛效果的影响。方法选取双孔胸腔镜下肺叶切除患者90例,采用随机数字表法分为对照组(C组)、胸椎旁神经阻滞组(T组)和单次胸椎旁神经阻滞联合竖脊肌平面阻滞组(T+E组),三组麻醉诱导和维持方案相同,记录术后6 h、12 h、24 h、48 h静息和咳嗽时的疼痛评分;记录麻醉诱导后(T0)、手术切皮时(T1)的血流动力学参数;测量入室后(T2)、肺叶切除即刻(T3)、手术结束后(T4)血清白细胞介素-6(IL-6)、Apelin-13水平;记录术后48 h内舒芬太尼用量及镇痛补救例数;记录恶心呕吐、气胸和尿潴留等术后不良反应的发生情况。结果与C组、T组相比,T+E组术后6、12、24和48 h静息和咳嗽时的疼痛评分更低(P<0.05),术后48 h内舒芬太尼用量更少(P<0.05),术后补救镇痛、恶心呕吐的发生率较低(P<0.05);与C组相比,T+E组T0、T1之间的血流动力学波动更小,T3、T4时间点的血清IL-6水平上升幅度明显降低,Apelin-13水平的下降幅度也明显降低(P均<0.05)。结论超声引导TPVB与ESPB联合可以为双孔胸腔镜患者提供较好的镇痛效果,更长的镇痛时间,降低了围术期的炎性反应,并减少了舒芬太尼的用量和阿片类药物相关的不良反应。Objective To study effects of preoperative ultrasond-guided thoracic paravertebral nerve block(TPVB)combined with erector spinus plane block(ESPB)on postoperative analgesia after double-pore thoracoscopic surgery.Methods 90 patients with double-port thoracoscopic lobectomy were randomly divided into control group(group C),thoracic paraverteal nerve block group(group T),and single thoracic paraverteal nerve block combined with erector ridge plane block group(group T+E)by using a random number table.Anesthesia induction and maintenance plan were the same as three groups.Pain scores at rest and cough were recorded at 6 h,12 h,24 h,48 h after surgery.Hemodynamic parameters were recorded after anesthesia induction(T0)and resection(T1).Serum IL-6 and Apelin-13 were measured after entry(T2),immediately after lobectomy(T3),and after surgery(T4).The dosage of sufentanil and the number of analgesic relief cases within 48 hours after operation were recorded.The incidence of postoperative adverse reactions such as nausea,vomiting,pneumothorax and urinary retention were recorded.Results Compared with C and T groups,T+E groups had lower pain scores at 6,12,24 and 48 hours after surgery at rest and cough(P<0.05),less sufentanil dosage at 48 hours after surgery(P<0.05),and lower incidence of postoperative relief analgesia,nausea and vomiting(P<0.05).Compared with C group,the hemodynamic fluctuation between T0 and T1 in T+E group was smaller,the increase of serum interleukin-6(IL-6)at T3 and T4 time points was significantly decreased,and the decrease of Apelin-13 was also significantly decreased(P<0.05).Conclusion Ultrasound guided TPVB in combination with ESPB could provide better analgesia,longer analgesia duration,reduced perioperative inflammatory response,and reduced sufentanil dosage and opioid-related adverse reactions in patients with dual-port thoracoscopy.

关 键 词：胸椎旁神经阻滞 竖脊肌平面阻滞 镇痛 白细胞介素-6 APELIN-13 

分 类 号：R614[医药卫生—麻醉学]