超声引导下竖脊肌平面阻滞对多发肋骨骨折患者术后早期呼吸功能的影响  

Effect of ultrasound-guided erector spinae plane block on early postoperative respiratory function in patients with multiple rib fractures

作　　者：于双[1] 王笑凡 林艳君[1] 郑少强 杨占民[1] 赵尧平 YU Shuang;WANG Xiaofan;LIN Yanjun;ZHENG Shaoqiang;YANG Zhanmin;ZHAO Yaoping(Department of Anesthesiology,Aerospace Central Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院麻醉科,北京100049 [2]首都医科大学附属北京积水潭医院麻醉科

出　　处：《临床麻醉学杂志》2024年第6期565-569,共5页Journal of Clinical Anesthesiology

基　　金：北京积水潭医院科研青年基金(QN-201915)。

摘　　要：目的探讨超声引导下竖脊肌平面阻滞(ESPB)对多发肋骨骨折(MRFs)患者术后早期呼吸功能和炎性因子的影响。方法选择2019年2月至2021年12月择期行多发肋骨骨折手术患者58例,男42例,女16例,年龄18~64岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:ESPB联合全身麻醉组(E组)和单纯全身麻醉组(G组),每组29例。E组于麻醉诱导后在侧卧位下实施超声引导下ESPB,给予0.5%罗哌卡因0.4 ml/kg。记录麻醉诱导前、出PACU时、术后24、48 h的用力肺活量(FVC)、动脉血气分析、静息和咳嗽时VAS疼痛评分。记录术后0~24 h、24~48 h的PCIA有效按压次数和补救镇痛情况。记录麻醉诱导前、术后24、48 h的IL-6和TNF-α浓度。结果与G组比较,E组出PACU时、术后24、48 h的FVC明显增大(P<0.05),PaCO_(2)、静息和咳嗽时VAS疼痛评分明显降低(P<0.05)。与G组比较,E组术后0~24 h、24~48 h的PCIA有效按压次数和补救镇痛率明显降低(P<0.05)。与G组比较,E组术后24、48 h的IL-6和TNF-α浓度明显降低(P<0.05)。结论超声引导下ESPB可为MRFs患者提供良好的术后镇痛,促进术后早期呼吸功能的恢复。Objective To investigate the effect of ultrasound-guided erector spinae plane block(ESPB)on early postoperative respiratory function and inflammatory cytokines in patients with multiple rib fractures(MRFs).Methods Fifty-eight patients who underwent MRFs surgery,42 males and 16 females,aged 18-64 years,BMI 18.5-30.0 kg/m^(2),ASA physical statusⅠorⅡ,were selected from February 2019 to December 2021.The patients were divided into two groups using random number method:ESPB combined with general anesthesia group(group E)and general anesthesia alone group(group G),29 patients in each group.All the patients in group E underwent ultrasound-guided ESPB in the lateral decubitus position after general anesthesia induction,and 0.5%ropivacaine 0.4 ml/kg was administered.Forced vital capacity(FVC),arterial blood gas analysis,VAS pain scores at rest and cough were recorded before anesthesia induction,at discharge from PACU,24 and 48 hours after operation.The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery and the number of rescue analgesia were recorded.The concentrations of IL-6 and TNF-αwere recorded before anesthesia induction,24 and 48 hours after operation.Results Compared with group G,the FVC was significantly higher,and the VAS score and PaCO_(2)were significantly lower in group E at discharge from PACU,24 and 48 hours after operation(P<0.05).The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery,the rate of rescue analgesia,the concentrations of IL-6 and TNF-α24 and 48 hours after operation in group E were significantly lower than those in group G(P<0.05).Conclusion Ultrasound-guided ESPB can provide good postoperative analgesia,promote early postoperative recovery of respiratory function in patients with MRFs.

关 键 词：竖脊肌平面阻滞 肋骨骨折 炎性因子 用力肺活量 超声引导 

分 类 号：R614[医药卫生—麻醉学]