比较前锯肌平面阻滞与胸椎旁神经阻滞在胸腔镜手术中的镇痛、镇静效果  

To Compare Analgesic and Sedation Effects of Serratus Anterior Plane Block and Thoracic Paravertebral Nerve Block During Thoracoscopic Surgery

作　　者：杨晓慧 舒运兵[2] 余得水[3] 唐昱英[1] Yang Xiaohui;Shu Yunbing;Yu Deshui(West China Second Hospital of Sichuan University,Chengdu,Sichuan 610041;Yibin Third People′s Hospital,Yibin,Sichuan 644000;Yibin Second People′s Hospital,Yibin,Sichuan 644000,China)

机构地区：[1]四川大学华西第二医院,四川成都610041 [2]宜宾市第三人民医院,四川宜宾644000 [3]宜宾市第二人民医院,四川宜宾644000

出　　处：《四川医学》2024年第6期596-600,共5页Sichuan Medical Journal

基　　金：成都市科技局项目(编号:2022-YF05-01261-SN)。

摘　　要：目的比较前锯肌平面阻滞与胸椎旁神经阻滞在胸腔镜手术中的镇痛、镇静效果。方法选取我院2022年7月至2023年7月收治的110例胸腔镜手术患者,采用随机数字表法分为两组,对照组55例采用胸椎旁神经阻滞,观察组55例采用前锯肌平面阻滞,比较两组麻醉效果、视觉模拟评分(VAS)、炎症因子水平、生命质量以及躁动率。结果观察组阻滞持续时间(13.63±3.16 vs.11.74±2.54)h长于对照组,阻滞操作时间(5.36±2.31 vs.10.19±2.55)min短于对照组,术后48 h镇痛泵按压次数(3.86±1.87 vs.5.91±1.54)次、术后舒芬太尼使用量(102.36±16.65 vs.128.77±20.33)μg少于对照组(P<0.05)。观察组术后6 h的VAS评分(3.68±1.11 vs.4.59±1.29)分、术后12 h的VAS评分(2.33±1.12 vs.3.57±1.43)分、术后24 h的VAS评分(1.84±0.52 vs.2.71±0.44)分、术后48 h的VAS评分(0.76±0.31 vs.1.49±0.55)分、术后2 h的IL-10(74.28±5.36 vs.98.57±6.44)ng/L、48 h的IL-10(45.13±4.29 vs.53.36±5.08)ng/L、术后2 h的IL-6(65.33±4.78 vs.76.49±5.78)ng/L、48 h的IL-6水平(47.79±3.36 vs.54.36±4.78)ng/L均低于对照组(P<0.05),术后24 h的SF-36评分(69.95±5.13 vs.65.33±4.27)分、术后48 h的SF-36评分(83.36±4.36 vs.74.29±3.69)分均高于对照组(P<0.05)。同时,观察组患者术后6 h、术后24 h、术后48 h的躁动率分别为(5.45%、3.64%、1.82%vs.18.18%、14.54%、12.73%),均低于对照组(P<0.05)。结论相比于胸椎旁神经阻滞,前锯肌平面阻滞在胸腔镜手术患者中效果更显著,具有良好的镇痛、镇静效果。Objective To compare analgesic and sedation effects between serratus anterior plane block and thoracic paravertebral nerve block in thoracoscopic surgery.Methods 110 patients in our hospital under went thoracoscopic surgery from July 2022 to July 2023 were selected.They were randomly divided into 2 groups using a random number table method.The control group consisted of 55 patients who received thoracic paravertebral nerve block,while the observation group consisted of 55 patients who received serratus anterior plane block.Anesthesia effect,visual analogue score(VAS),inflammatory factor levels,quality of life,and restlessness rate were compared.Results Greater duration of block of observation group was longer than control group(13.63±3.16 vs.11.74±2.54)h,shorter block maneuver time than control group(5.36±2.31 vs.10.19±2.55)min,postoperative 48 hours analgesia pump press frequency was less than control group(3.86±1.87 vs 5.91±1.54),postoperative sufentanyl use was less than control group(102.36±16.65 vs.128.77±20.33)μg(P<0.05).For observation group,VAS score at 6 h(3.68±1.11 vs.4.59±1.29),VAS at 12 h(2.33±1.12 vs.3.57±1.43),VAS at 24 h(1.84±0.52 vs.2.71±0.44),VAS at 48 h(0.76±0.31 vs.1.49±0.55),IL-10 at 2 h(74.28±5.36 vs.98.57±6.44)ng/L,IL-10 at 48 h(45.13±4.29 vs.53.36±5.08)ng/L,IL-6 at 2 h(65.33±4.78 vs.76.49±5.78)ng/L,IL-6 at 48 h(47.79±3.36 vs.54.36±4.78)ng/L were lower than those of control group(P<0.05).The SF-36 score at 24 h after operation(69.95±5.13 vs.65.33±4.27)and SF-36 score at 48 h(83.36±4.36 vs.74.29±3.69)were all higher than control group(P<0.05).Meanwhile,the agitation rates of 6 h,24 h and 48 h in the observation group were(5.45%,3.64%,1.82%vs.18.18%,14.54%and 12.73%,respectively),which were lower than those of control group(P<0.05).Conclusion Compared to thoracic paravertebral nerve block,serratus anterior plane block would have a more significant effect in patients undergoing thoracoscopic surgery,with good analgesic and sedative effects.

关 键 词：前锯肌平面阻滞 胸椎旁神经阻滞 胸腔镜手术 疼痛 炎症因子 生命质量 

分 类 号：R614.4[医药卫生—麻醉学]