漏斗胸患儿Nuss术麻醉的优化策略:超声引导竖脊肌平面阻滞联合全身麻醉  

Optimization strategies of anesthesia for pediatric patients with pectus excavatum undergoing Nuss procedure:ultrasound-guided erector spinae plane block combined with general anesthesia

作　　者：任艺 滑蕾 张富洲[1] 马阳巍 郑铁华[1] 许增华 张建敏[1] Ren Yi;Hua Lei;Zhang Fuzhou;Ma Yangwei;Zheng Tiehua;Xu Zenghua;Zhang Jianmin(Department of Anesthesiology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科,北京100045

出　　处：《中华麻醉学杂志》2024年第8期972-976,共5页Chinese Journal of Anesthesiology

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.19089-102)。

摘　　要：目的评价超声引导竖脊肌平面阻滞联合全身麻醉对漏斗胸患儿Nuss术的优化效果。方法择期拟行Nuss术漏斗胸患儿108例,性别不限,年龄7~18岁,BMI均在正常范围内,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=36):超声引导竖脊肌平面阻滞(ESPB)联合全身麻醉组(E组)、胸段硬膜外镇痛(TEA)联合全身麻醉(T组)和全身麻醉组(G组)。E组和T组患儿于麻醉诱导后分别接受超声引导双侧ESPB[注射0.3%罗哌卡因,双侧总量0.5 ml/kg(最大量20 ml)]或TEA[注射0.3%罗哌卡因0.5 ml/kg(最大量20 ml)],3组均行全身麻醉,静脉注射丙泊酚2~3 mg/kg、舒芬太尼0.3~0.5μg/kg和顺式阿曲库铵0.1~0.2 mg/kg麻醉诱导气管插管后行机械通气,静脉输注丙泊酚6~10 mg·kg^(-1)·h^(-1)和瑞芬太尼0.1~0.3μg·kg^(-1)·min-1维持麻醉。术后3组均行舒芬太尼PCIA。记录术中瑞芬太尼用量、术后各时段舒芬太尼PCIA用量、术后首次补救镇痛时间、布洛芬用量和术后并发症的发生情况。结果与G组相比,E组和T组术中瑞芬太尼用量和术后各时段舒芬太尼PCIA用量降低,首次补救镇痛时间延长,布洛芬用量减少(P<0.05)。3组术后并发症发生率比较差异无统计学意义(P>0.05)。结论ESPB联合全身麻醉有助于减轻漏斗胸患儿Nuss术后痛觉过敏。ObjectiveTo evaluate the optimization effect of ultrasound-guided erector spinae plane block(ESPB)combined with general anesthesia on Nuss procedure in pediatric patients with pectus excavatum undergoing Nuss procedure.MethodsOne hundred and eight pediatric patients of either sex,aged 7-18 yr,with body mass index within the normal range,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective Nuss procedure,were randomized into 3 groups(n=36 each)using a random number table method:ultrasound-guided ESPB combined with general anesthesia group(group E),thoracic epidural anesthesia plus general analgesia group(group T),and general analgesia group(group G).Pediatric patients received ultrasound-guided bilateral ESPB(0.3%ropivacaine was injected,0.5 ml/kg bilateral total volume[maximum 20 ml])or thoracic epidural anesthesia(0.3%ropivacaine 0.5 ml/kg[maximum 20 ml/side])after induction of anesthesia in group E and group T,respectively.All the three groups underwent general anesthesia,anesthesia was induced with propofol 2-3 mg/kg,sufentanil 0.3-0.5μg/kg and cis-atracurium 0.1-0.2 mg/kg and maintained with propofol 6-10 mg·kg^(-1)·h^(-1) and remifentanil 0.1-0.3μg·kg^(-1)·min-1.The patients were endotracheally intubated and mechanically ventilated after anesthesia induction.The parent-controlled intravenous analgesia(PCIA)was used for patients in all the three groups postoperatively.The consumption of intraoperative remifentanil and postoperative consumption of sufentanil for PCIA in each period after surgery were recorded.The time to the first rescue analgesia,consumption of ibuprofen and postoperative complications were also recorded.ResultsCompared with group G,the intraoperative consumption of remifentanil and postoperative consumption of sufentanil for PCIA in each period were significantly decreased,the time to the first rescue analgesia was prolonged,and the consumption of ibuprofen was decreased in group E(P<0.05).There was no significant difference among the thre

关 键 词：竖脊肌 神经传导阻滞 麻醉 全身 漏斗胸 儿童 痛觉过敏 

分 类 号：R726.1[医药卫生—儿科]