胸骨旁胸大肌肋间肌平面阻滞与竖脊肌平面阻滞在心脏手术中的应用比较  

Comparison of the application of parasternal pectoralis major intercostal plane block and erectorspinae plane block in cardiac surgery

作　　者：谭其莲 张勇[1] 方兆晶[1] 王振红[1] 蒋婷婷[1] 王宏宇[1] Tan Qilian;Zhang Yong;Fang Zhaojing;Wang Zhenhong;Jiang Tingting;Wang Hongyu(Department of Anesthesiology,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)麻醉科,南京210006

出　　处：《中国医师杂志》2024年第10期1525-1529,共5页Journal of Chinese Physician

基　　金：2024年度江苏省科技智库计划(调研课题)项目;南京市卫生科技发展专项资料项目(YKK19081)。

摘　　要：目的评价胸骨旁胸大肌肋间肌平面(PIFP)阻滞与竖脊肌平面(ESP)阻滞应用于正中开胸心脏手术术后镇痛的安全性和有效性。方法选择2022年10月至2023年10月南京医科大学附属南京医院择期行正中开胸心脏手术患者158例,按随机数字表法分为PIFP阻滞组(P组)以及ESP阻滞组(E组),每组79例。麻醉手术前,P组在超声引导下行双侧PIFP阻滞,E组在超声引导下行双侧ESP阻滞,术后均采用舒芬太尼静脉自控镇痛。记录两组患者术后6、12、18、24h静息和活动视觉模拟量表(VAS)评分;记录患者术后自控镇痛泵首次按压时间、24h舒芬太尼累计用量、有效按压次数及补救镇痛率;记录拔管时间、ICU住院时间以及不良反应发生情况;记录神经阻滞操作时间、超声下穿刺针显像清晰度评分以及神经阻滞患者满意度。结果两组术后6、12、18、24h静息VAS评分以及18、24h活动VAS评分组间差异无统计学意义(均P>0.05),P组术后6、12h活动VAS评分低于E组(均P<0.05);与E组相比,P组患者术后镇痛泵的首次按压时间明显更长(均P<0.05),补救镇痛率、术后24h舒芬太尼累计用量及镇痛泵有效按压次数明显更少(均P<0.05);两组患者拔管时间、ICU住院时间以及恶心呕吐发生率比较差异无统计学意义(均P>0.05);与E组比较,P组神经阻滞操作时间更短、超声下穿刺针显像清晰度评分更高并且患者满意度更高(均P<0.05)。结论较之ESP阻滞,PIFP阻滞可为心脏手术患者提供更加良好的围手术期镇痛,减少阿片类药物的使用,且PIFP阻滞操作更简单,具有良好的安全性和有效性。Objective To evaluate the safety and effectiveness of pecto-intercostal fascial plane(PIFP)block and erector spinae plane(ESP)block for postoperative analgesia in median open heart surgery.Methods A total of 158 patients who underwent elective midline open heart surgery at the Nanjing First Hospital,Nanjing Medical University from October 2022 to October 2023 were randomly divided into a PIFP block group(P group)and ESP block group(E group)using a random number table method,with 79 patients in each group.Before anesthesia surgery,the group P underwent ultrasound-guided bilateral PIFP block,while the group E underwent ultrasound-guided bilateral ESP block.Both groups received sufentanil intravenous patient-controlled analgesia after surgery.The resting and activity Visual Analog Scale(VAS)scores of two groups of patients at 6,12,18,and 24 hours after surgery were recorded;The first press time of the patient's postoperative patient-controlled analgesia pump,the cumulative dose of sufentanil within 24 hours,the number of effective presses,and the rate of salvage analgesia were recorded;and extubation time,intensive care unit(ICU)stay,and adverse reactions;the time of nerve block operation,clarity score of puncture needle imaging under ultrasound,and patient satisfaction with nerve block were also recorded.Results There was no statistically significant difference in resting VAS scores and activity VAS scores between the two groups at 6,12,18,and 24 hours after surgery(all P>0.05).The activity VAS scores of the group P were lower than those of the group E at 6 and 12 hours after surgery(all P<0.05);Compared with the group E,patients in the group P had significantly longer first press time of postoperative analgesia pump(all P<0.05),lower salvage analgesia rate,cumulative dose of sufentanil 24 hours after surgery,and fewer effective presses of analgesia pump(all P<0.05);There was no statistically significant difference in extubation time,ICU stay,and incidence rate of nausea between the two groups of patients(all P>0.0

关 键 词：麻醉 心脏手术 神经传导阻滞 胸大肌肋间肌平面阻滞 竖脊肌平面阻滞 

分 类 号：R614[医药卫生—麻醉学]