胸肋间筋膜阻滞对心脏瓣膜置换术后早期恢复质量的影响  

Effect of pectointercostal fascial block on early postoperative quality of recovery in patients undergoing cardiac valve replacement

作　　者：方兆晶[1] 张勇[1] 王晓亮[1] 史宏伟[1] 鲍红光[1] 赵倩[1] FANG Zhaojing;ZHANG Yong;WANG Xiaoliang;SHI Hongwei;BAO Hongguang;ZHAO Qian(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,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,210006

出　　处：《临床麻醉学杂志》2024年第3期243-247,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨胸肋间筋膜阻滞(PIFB)对心脏瓣膜置换术后早期恢复质量的影响。方法选择择期行正中切口心脏瓣膜置换术患者80例,男45例,女35例,年龄44~75岁,BMI 18~30 kg/m 2,ASAⅡ或Ⅲ级,随机分为两组:全麻联合PIFB组(P组)和全麻组(C组),每组40例。P组麻醉诱导后行双侧胸肋间筋膜平面阻滞,C组不行神经阻滞,术后均使用舒芬太尼静脉自控镇痛。采用15项恢复质量评分量表(QoR-15)评价术前24 h、术后24、72 h恢复情况,记录诱导前、切皮时、锯胸骨时、关胸时、出手术室时的HR和MAP,拔管后4、8、12 h静息和活动(咳嗽)时VAS疼痛评分。记录术中和术后48 h内舒芬太尼用量、拔管时间、重症监护病房(ICU)停留时间、术后首次肛门排气时间、术后住院时间,术后恶心呕吐、低血压、呼吸抑制等不良反应的发生情况和住院期间死亡情况。结果与C组比较,P组术后24、72 h QoR-15评分明显升高(P<0.05),拔管后4、8、12 h静息和活动时VAS疼痛评分明显降低(P<0.05),术中和术后48 h内舒芬太尼用量明显减少(P<0.05),拔管时间、术后首次肛门排气时间、ICU停留时间明显缩短(P<0.05),术后恶心呕吐发生率明显降低(P<0.05)。两组不同时点HR和MAP、术后住院时间、住院期间死亡率差异无统计学意义。P组未发生神经阻滞相关并发症。结论PIFB可以降低正中切口心脏瓣膜置换手术患者术后疼痛,提高术后恢复质量,促进术后康复。Objective To investigate the effect of ultrasound-guided pectointercostal fascial block(PIFB)on early postoperative quality of recovery in cardiac valve replacement.Methods Eighty patients,45 males and 35 females,aged 44-75 years,BMI 18-30 kg/m 2,ASA physical statusⅡorⅢ,who underwent cardiac valve replacement through median sternotomy were randomly divided into two groups:general anesthesia combined with PIFB group(group P)and general anesthesia group(group C),40 patients in each group.After anesthesia induction,the patients in group P underwent bilateral PIFB guided by ultrasound while group C was not subjected to block operation.The patients in both groups were routinely received sufentanil for patient-controlled intravenous analgesia(PCIA)after surgery.The 15-item quality of recovery(QoR-15)scale was used to assess the early postoperative quality of recovery at 24 hours before surgery and 24 and 72 hours after surgery.The HR and MAP were recorded before induction of anaesthesia,at the time of skin incision,sternum sawing,chest closure,and leaving the operating room.The visual analogue scale(VAS)pain scores of patients at rest and during activity(cough)at 4,8,and 12 hours after extubation,dosage of sufentanil during operation and 48 hours after operation were recorded,the extubation time,length of ICU,the first exhaust time,length of the postoperative hospital stay were recorded.The occurrence of postoperative nausea and vomiting,hypotension,respiratory depression,mortality during hospitalization and other adverse reactions were recorded.Results Compared with group C,the QoR-15 scores at 24 and 72 hours after surgery were increased,VAS pain scores at rest or during activity at each time point after extubation,the intraoperative and postoperative sufentanil dose were decreased,the extubation time,length of ICU,and the first exhaust time were shortened in group P(P<0.05).The incidence of nausea and vomiting in group P was lower than that in group C(P<0.05).HR and MAP at each time point,and hospital stay,morta

关 键 词：胸肋间筋膜阻滞 心脏瓣膜置换术 正中胸骨切口 术后恢复质量 

分 类 号：R614[医药卫生—麻醉学]