对比分析单次竖脊肌平面阻滞与术中肋间神经阻滞分别联合静脉自控镇痛对胸腔镜肺叶切除患者术后恢复质量的影响  

Comparative analysis of the effects of single erector spinal muscle plane block and intraoperative intercostal nerve block combined with venous patient controlled analgesia on postoperative recovery quality in patients with video assisted thoracic surgery

作　　者：包义勇 程冰 丁美平 BAO Yi-yong;CHENG Bing;DING Mei-ping(Department of Anesthesiology,Xuancheng City Central Hospital,Xuancheng Anhui 242000,China)

机构地区：[1]宣城市中心医院麻醉科,安徽宣城242000

出　　处：《临床和实验医学杂志》2023年第21期2350-2352,F0003,共4页Journal of Clinical and Experimental Medicine

基　　金：安徽省卫生健康适宜技术项目(编号:SYJS-201915)。

摘　　要：目的分析单次竖脊肌平面阻滞(ESPB)与术中肋间神经阻滞(INB)分别联合患者静脉自控镇痛(PCIA)对胸腔镜肺叶切除术(VATS)患者术后恢复情况的影响。方法前瞻性选取2019年1月至2022年12月在宣城市中心医院接受VATS治疗的120例患者进行研究,按照随机数字表法将患者分为PCIA组、INB+PCIA组和ESPB+PCIA组,每组各40例。PCIA组给予单纯PCIA,INB+PCIA组给予INB联合PCIA,ESPB+PCIA组给予ESPB联合PCIA。分析3组患者术后1、6、12、24 h的疼痛程度,术后24 h镇痛相关指标(镇痛泵按压次数、输注总量)、肺功能[第1秒呼气容积(FEV1)、用量肺活量(FVC)、FEV1/FVC]、术后恢复相关指标(胸管拔除时间、首次下床时间、住院时间)和并发症。结果术后1、6、12、24 h,ESPB+PCIA组的视觉模拟评分法(VAS)评分均较INB+PCIA组、PCIA组低,INB+PCIA较PCIA组低,差异均有统计学意义(P<0.05)。术后24 h,ESPB+PCIA组的镇痛泵按压次数、输注总量均较INB+PCIA组、PCIA组少,INB+PCIA较PCIA组少,差异均有统计学意义(P<0.05)。术后24 h,ESPB+PCIA组的FEV1、FVC、FEV1/FVC水平均较INB+PCIA组、PCIA组高,INB+PCIA组较PCIA组高,差异均有统计学意义(P<0.05)。ESPB+PCIA组的胸管拔除时间、首次下床时间、住院时间均较INB+PCIA组、PCIA组短,INB+PCIA较PCIA组短,差异均有统计学意义(P<0.05)。INB+PCIA组、ESPB+PCIA组并发症发生率分别为7.50%、5.00%,均较PCIA组(25.00%)低,差异均有统计学意义(P<0.05)。结论ESPB和INB联合PCIA在VATS镇痛中均具有一定安全性,但前者对患者肺功能影响较小,能够更好地保障术后镇痛效果,有利于提升患者的术后早期恢复质量。Objective To analyze the effects of single erector spinae plane block(ESPB)and intraoperative intercostal nerve block(INB)combined with patient controlled intravenous analgesia(PCIA)on postoperative recovery quality in patients with video assisted thoracic surgery(VATS).Methods A prospective study was conducted on 120 patients who received VATS treatment at Xuancheng City Central Hospital from January 2019 to December 2022.The patients were divided into PCIA group,INB+PCIA group,and ESPB+PCIA group according to the random number table method,with 40 patients in each group.The PCIA group received pure PCIA,the INB+PCIA group received INB combined with PCIA,and the ESPB+PCIA group received ESPB combined with PCIA.The postoperative pain degree at 1,6,12 and 24 h after surgery,analgesia related indexes(number of analgesic pump presses and total infusion volume),lung function[forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC],postoperative recovery related indexes(chest tube removal time,first time out of bed,and hospitalization time)at 24 h after surgery and complications of the three groups were analyzed.Results The visual analogue scale(VAS)scores at 1,6,12 and 24 h after surgery in ESPB+PCIA group were lower than in INB+PCIA group and PCIA group,and those in the INB+PCIA group were lower than those in PCIA group,the differences were statistically significant(P<0.05).At 24 h after surgery,the number of analgesic pump presses and total infusion volume in the ESPB+PCIA group were lower than those in the INB+PCIA group and PCIA group,and those in the INB+PCIA group was lower than those in the PCIA group,the differences were statistically significant(P<0.05).At 24 h after surgery,the levels of FEV1,FVC,FEV1/FVC in ESPB+PCIA group were higher than those in INB+PCIA group and PCIA group,and those in the INB+PCIA group were higher than those in PCIA group,the differences were statistically significant(P<0.05).The chest tube removal time,first time out of bed,and hospitalization time of the E

关 键 词：镇痛 竖脊肌平面阻滞 肋间神经阻滞 患者静脉自控镇痛 胸腔镜肺叶切除术 肺功能 早期恢复质量 

分 类 号：R614[医药卫生—麻醉学]