胸横肌联合前锯肌平面阻滞对心脏瓣膜置换术患者术后镇痛及心肌保护的影响  

Effect of transverse thoracic muscle combined with serratus anterior muscle plane block on postoperative analgesia and myocardial protection in patients undergoing heart valve replacement

作　　者：张淑琪 邢珍[2] ZHANG Shuqi;XING Zhen(Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Anesthesia,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院,河北张家口075000 [2]河北北方学院附属第一医院麻醉科,河北张家口075000

出　　处：《重庆医学》2023年第20期3148-3153,共6页Chongqing medicine

基　　金：河北省财政厅老年病防治项目(冀财预复[2020]459号)。

摘　　要：目的探讨胸横肌联合前锯肌平面阻滞对心脏瓣膜置换术患者术后镇痛及心肌保护的影响。方法选择河北北方学院附属第一医院50例行全身麻醉下心脏瓣膜置换术的患者,随机分为对照组(C组)和研究组(R组),每组25例。R组患者行超声引导下双侧胸横肌联合前锯肌平面阻滞,C组不给予阻滞。术后均给予患者自控静脉镇痛(PCIA)。记录患者术中芬太尼总使用量、拔管后补救镇痛地佐辛的用量、拔管后静息及咳嗽两种状态下视觉模拟量表(VAS)评分,检测不同时点B型钠尿肽(BNP)、心肌肌钙蛋白(cTnⅠ)及炎性因子(IL-6及IL-10)水平,以及平均动脉压(MAP)和心率(HR),观察患者术后首次清醒时间、拔管时间。结果与C组相比,R组术中芬太尼总用量及拔管后补救镇痛地佐辛用量减少,拔管后咳嗽时VAS评分降低,术后首次清醒及拔管时间均较早;T8(CPB开始后30 min)、T9(CPB结束后30 min)、T10(术后24 h)时IL-6水平降低,IL-10水平升高;T10时BNP、cTnⅠ水平降低;T3(切皮后1 min)、T4(胸骨正中锯开后1 min)时MAP及HR降低,差异均有统计学意义(P<0.05)。结论全身麻醉下正中开胸心脏瓣膜置换术中采用超声引导下胸横肌联合前锯肌平面阻滞可减少阿片类药物的用量,削弱炎性应激反应,对心肌有一定的保护作用。Objective To investigate the effect of transverse thoracic muscle combined with serratus anterior muscle plane block on postoperative analgesia and myocardial protection in patients undergoing heart valve replacement.Methods A total of 50 patients who underwent heart valve replacement under general anesthesia in the First Affiliated Hospital of Hebei North University were randomly divided into the control group(group C),and the research group(group R),with 25 cases in each group.Patients in group R were treated with ultrasound-guided bilateral transverse thoracic muscle combined with serratus anterior plane block,while patients in group C were not given block.All patients were given patient-controlled intravenous analgesia(PCIA)after operation.The total dosage of fentanyl during operation,the dosage of dezocine as a remedial analgesic after extubation,the visual analogue scale(VAS)scores at rest and cough after extubation were recorded,and the levels of B-type natriuretic peptide(BNP),cardiac troponin(cTnⅠ)and inflammatory factors(IL-6 and IL-10),as well as the average arterial pressure(MAP)and heart rate(HR)at different time points were detected.Results Compared with group C,the total dosage of fentanyl during operation and the dosage of dezocine for remedial analgesia after extubation in group R decreased,the VAS score of cough after extubation decreased,and the first postoperative awakening and extubation time were earlier.At T8[(30 min after the beginning of cardiopulmonary bypass(CPB)],T9(30 min after CPB)and T10(24 h after operation),the level of IL-6 decreased and the level of IL-10 increased.The levels of BNP and cTnⅠdecreased at T10.MAP and HR decreased at T3(1 min after skin incision)and T4(1 min after median sternotomy),and the differences were statistically significant(P<0.05).Conclusion With ultrasonic guidance,the transverse thoracic muscle combined with serratus anterior muscle plane block in heart valve replacement under general anesthesia can reduce the dosage of opioids,weaken inflammatory s

关 键 词：胸横肌平面阻滞 前锯肌平面阻滞 心脏瓣膜置换术 术后镇痛 应激反应 心肌保护 

分 类 号：R614.2[医药卫生—麻醉学]