超声引导下双侧椎板后阻滞对体外循环下心脏瓣膜置换术患者术后镇痛及心肌保护的影响  

Effect of ultrasound-guided bilateral posterior laminar block on postoperative analgesia and myocardial protection in patients with heart valve replacement under cardiopulmonary bypass

作　　者：王棣馨[1] 曹慧灵[1] 孙燕[1] 刘少星[1] WANG Dixin;CAO Huiling;SUN Yan;LIU Shaoxing(Department of Anesthesiology,Chengdu Municipal Second People’s Hospital,Chengdu,Sichuan 610083,China)

机构地区：[1]成都市第二人民医院麻醉科,成都610083

出　　处：《重庆医学》2024年第12期1828-1833,共6页Chongqing medicine

基　　金：四川省卫生健康委员会医学科技项目(21PJ141)。

摘　　要：目的探讨超声引导下双侧椎板后阻滞(RLB)对体外循环(CPB)下心脏瓣膜置换术患者术后镇痛及心肌保护的影响。方法选取该院2022年5月至2023年3月拟在CPB下行瓣膜置换术的70例患者为研究对象,采用随机数字表法分为单纯全身麻醉组(A组)和超声引导下双侧RLB复合全身麻醉组(B组),每组35例。A组无特殊处理;B组患者麻醉诱导前在超声引导下经第4胸椎椎板水平行双侧RLB。所有患者手术结束后均使用患者自控静脉镇痛(PCIA)泵。记录两组患者麻醉诱导前(T_(0))、插管时(T_(1))、切开胸骨时(T_(2))、CPB前(T_(3))、CPB停止10 min时(T_(4))及手术结束后5 min时(T_(5))的平均动脉压(MAP)及心率(HR);记录两组患者术后首次清醒时间、拔管时间及拔管后在静息、咳嗽两种状态下的数字疼痛量表(NRS)评分;记录两组患者术中舒芬太尼用量、拔管后用于补救镇痛的羟考酮用量;于T_(0)、CPB开始后30 min(T_(6))、CPB结束后30 min(T_(7))、术后24 h(T_(8))、术后48 h(T_(9))时采用ELISA检测丙二醛(MDA)、超氧化物歧化酶(SOD)、心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)水平;记录两组患者恶心呕吐、穿刺部位感染、局部麻醉药中毒及穿刺损伤等不良事件发生情况。结果与A组比较,B组在T_(1)、T_(2)和T_(3)时MAP及HR明显降低;术后首次清醒时间及拔管时间均提前;拔管后静息、咳嗽NRS评分明显降低;舒芬太尼、羟考酮用量均减少;T_(6)、T_(7)、T_(8)时MDA、cTnI和CK-MB水平明显降低,SOD水平明显升高,差异有统计学意义(P<0.05)。两组患者均无恶心呕吐、穿刺部位感染、局部麻醉药中毒及穿刺损伤等不良事件的发生。结论超声引导下双侧RLB可稳定CPB心脏瓣膜置换术患者术中血流动力学及提供完善的镇痛,同时减轻应激反应,起到一定的心肌保护作用。Objective To investigate the effect of ultrasound-guided bilateral retrolaminar block(RLB)on postoperative analgesia and myocardial protection in the patients with heart valve replacement under cardiopulmonary bypass(CPB).Methods A total of 70 patients with scheduled valve replacement under CPB in this hospital from May 2022 to March 2023 were selected as the study subjects and divided into the simple general anesthesia group(group A)and ultrasound-guided bilateral RLB combined general anesthesia group(group B)by the random number table method,35 cases in each group.There was no special treatment in the group A;before anesthesia induction,the group B underwent bilateral RLB under ultrasound guidance through the laminar level of the fourth thoracic vertebra.All patients used the patient-controlled intravenous analgesia(PCIA)pump after surgery.The mean arterial pressure(MAP)and heart rate(HR)of the two groups were recorded before anesthesia induction(T_(0)),during intubation(T_(1)),during sternal incision(T_(2)),before CPB(T_(3)),at 10 min after CPB stop(T_(4))and at 5 min after surgery(T_(5)).The time of first awakening,extubation time and scores of the Numeric Pain Scale(NRS)in the resting and coughing states after extubation were recorded in the two groups.The dose of intraoperative sufentanil and the oxycodone dose for remedy analgesia after extubation were recorded in the two groups.The levels of malondialdehyde(MDA),superoxide dismutase(SOD),cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)were detected by ELISA at T 0,30 min after CPB beginning(T_(6)),30 min after CPB end(T_(7)),postoperative 24 h(T_(8))and 48 h(T_(9)).The occurrence situation of adverse events such as nausea and vomiting,puncture site infection,local anesthetic poisoning and puncture injury were recorded in the two groups.Results Compared with the group A,MAP and HR at T_(1),T_(2) and T_(3) in the group B were significantly decreased.The time of first awakening and extubation after surgery were advanced.After extubation,the NRS s

关 键 词：超声 椎板后阻滞 瓣膜置换术 术后镇痛 心肌保护 

分 类 号：R614[医药卫生—麻醉学]