超声引导下胸骨旁胸大肌肋间肌平面阻滞与胸横肌平面阻滞用于全麻冠状动脉旁路移植术效果的比较  

Efficacy of pecto-intercostal fascial plane block versus transversus thoracic muscle plane block under ultrasound guidance in coronary artery bypass grafting with general anesthesia

作　　者：尹海玲 葛亚力[1] 魏海燕[1] 苏中宏[1] 史宏伟[1] 施韬[1] 尹加林[1] Yin Hailing;Ge Yali;Wei Haiyan;Su Zhonghong;Shi Hongwei;Shi Tao;Yin Jialin(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉疼痛与围术期医学科,南京210006

出　　处：《中华麻醉学杂志》2024年第2期194-198,共5页Chinese Journal of Anesthesiology

摘　　要：目的比较超声引导下胸骨旁胸大肌肋间肌平面(PIFP)阻滞与胸横肌平面(TTP)阻滞用于全麻冠状动脉旁路移植术的效果。方法择期冠状动脉旁路移植术患者90例,性别不限,年龄50~79岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为3组(n=30):PIFP阻滞联合全麻组(PG组)、TTP阻滞联合全麻组(TG)和单纯全麻组(G组)。麻醉诱导后,PG组和TG组在超声引导下分别进行双侧PIFP阻滞和TTP阻滞。3组全麻方法相同。术后均采用PCIA。于术后6、12、18和24 h时记录静态和动态(咳嗽、体位变动等)VAS评分;记录术中舒芬太尼总用量、气管拔管时间、ICU停留时间、补救镇痛率、镇痛泵有效按压次数、术后恶心呕吐、皮肤瘙痒发生情况以及神经阻滞相关不良事件发生情况;记录PG组和TG组神经阻滞操作时间、超声下穿刺针显像清晰度评分。结果与G组比较,PG组和TG组术中舒芬太尼总用量减少,气管拔管时间和ICU停留时间缩短,术后6、12、18 h时静态和动态VAS评分降低,补救镇痛率降低,镇痛泵有效按压次数减少(P<0.05);PG组和TG组上述指标比较差异无统计学意义(P>0.05)。与TG组比较,PG组神经阻滞操作时间缩短,超声下穿刺针显像清晰度评分升高(P<0.05);PG组和TG组均未见神经阻滞相关不良事件发生。3组恶心、呕吐、皮肤瘙痒发生率比较差异无统计学意义(P>0.05)。结论 PIFP阻滞可为全麻冠状动脉旁路移植术患者提供良好的围术期镇痛,促进患者快速康复。虽然镇痛效果与TTP阻滞相似,但因PIFP阻滞操作更简单,相对风险更小,因此更具临床应用价值。Objective To compare the efficacy of pecto-intercostal fascial plane(PIFP)block versus transversus thoracic muscle plane(TTP)block under ultrasound guidance in coronary artery bypass grafting with general anesthesia.Methods Ninety American Society of Anesthesiologists Physical Status classificationⅡorⅢpatients of either sex,aged 50-79 yr,scheduled for elective coronary artery bypass grafting,were divided into 3 groups(n=30 each)using a random number table method:PIFP block combined with general anesthesia group(PG group),TTP block combined with general anesthesia group(TG group),and general anesthesia group(G group).After anesthesia induction,bilateral PIFP block was performed under ultrasound guidance in group PG,TTP block was performed under ultrasound guidance in group TG.Three groups used the same general anesthesia method and patient-controlled intravenous analgesia after surgery.Visual analog scale scores(cough,position change,etc)at rest and during activity were recorded at 6,12,18 and 24 h after operation.The total consumption of intraoperative sufentanil,extubation time,length of stay in intensive care units,rate of rescue analgesia,effective pressing times of patient-controlled analgesia,incidence of postoperative nausea and vomiting,skin pruritus and nerve block-related adverse events were recorded.The operation time of nerve block was recorded and ultrasound-guided needle visibility score was assessed in PG group and TG group.Results Compared with group G,the total consumption of intraoperative sufentanil was significantly reduced,the extubation time and length of stay in intensive care units were shortened,visual analog scale scores at rest and during activity were decreased at 6,12 and 18 h after operation,the rate of rescue analgesia was decreased,and the effective pressing times of patient-controlled analgesia were decreased in group PG and group TG(P<0.05),and no significant change was found in the aforementioned parameters in PG and TG groups(P>0.05).Compared with group TG,the operational ti

关 键 词：冠状动脉分流术 神经传导阻滞 胸骨旁胸大肌肋间肌平面 胸横肌平面 

分 类 号：R614[医药卫生—麻醉学]