RISS阻滞在胸腔镜肺癌根治术后镇痛中的临床应用  

Clinical Application of RISS Block in Postoperative Analgesia after Thoracoscopic Radical Resection of Lung Cancer

作　　者：高强[1] 彭英[1] 胡默昂[2] 张彦[3] Gao Qiang;Peng Ying;Hu Moang;Zhang Yan(Department of Anesthesiology,Chengdu Fifth People's Hospital(i.e.Fifth People's Hospital Afiliated to Chengdu University of Traditional Chinese Medicine),Chengdu 611130,Sichuan,China;Department of Thoracic Surgery,Chengdu Fifth People's Hospital(i.e.Fifth People's Hospital Afiliated to Chengdu University of Traditional Chinese Medicine),Chengdu 611130,Sichuan,China;Department of Cardiothoracic Surgery,Affliated Hospital of Chengdu University,Chengdu 610081,Sichuan,China)

机构地区：[1]成都市第五人民医院/成都中医药大学附属第五人民医院麻醉科,成都611130 [2]成都市第五人民医院/成都中医药大学附属第五人民医院胸外科,成都611130 [3]成都大学附属医院胸心外科,成都610081

出　　处：《肿瘤预防与治疗》2024年第11期954-959,共6页Journal of Cancer Control And Treatment

基　　金：成都市医学科研课题(编号:2023490)。

摘　　要：目的:探讨超声引导下菱形肌-肋间肌-低位前锯肌平面(rhomboid intercostal and subserratus plane,RISS)阻滞对胸腔镜下肺癌根治术患者术后镇痛的临床效果,并评价RISS阻滞的安全性和有效性。方法:前瞻性收集2023年1~8月在成都市第五人民医院择期行肺癌根治术患者80例作为研究对象,采用随机数字表法分为:R组:RISS阻滞+自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)组和对照组(C组):单纯PCIA。记录并比较两组主要结局及次要结局指标,主要结局指标为:术后镇痛效果,即术后2、6、12、24、72 h的静息和咳嗽视觉模拟量表(Visual Analogue Scale,VAS)疼痛评分。次要结局指标包括:(1)术后镇痛药物使用情况,即术后24h内舒芬太尼的用量、镇痛泵有效按压次数和补救性镇痛追加次数;(2)术后镇痛期间不良反应发生情况,即头晕、嗜睡、术后恶心呕吐(postoperative nausea and vomiting,PONV)、低血压、尿潴留等发生率;(3)镇痛满意度。结果:R组患者术后2 h、6 h、12 h、24 h、72 h静息VAS评分和咳嗽VAS评分均低于C组,差异均有统计学意义(P<0.05)。R组患者在术后24 h内舒芬太尼用量、镇痛泵有效按压次数及补救性镇痛的追加次数均明显低于C组,差异有统计学差异(P<0.05)。R组患者头晕和PONV的发生率低于C组,差异有统计学差异(P<0.05)。两组患者术后镇痛满意度之间存在统计学差异(P<0.05),R组的总体满意度高于C组。结论:超声引导下RISS阻滞可以为胸腔镜下肺癌根治术后提供良好的术后镇痛,可以减少术后镇痛药物需求及术后不良反应发生率,提高患者术后镇痛满意度。Objective:To explore the clinical effect,safety and effectiveness of ultrasound-guided rhomboid intercostal and subserratus plane(RISS)block for postoperative analgesia after thoracoscopic radical resection of lung cancer.Methods:80 lung cancer patients undergoing thoracoscopic radical resection in Chengdu Fifth People's Hospital from January 2023 to August 2023 were prospectively collected as research objects.They were divided into two groups by using random number table:Group R(RISS block+patient controlled intravenous analgesia)and Group C(patient controlled intravenous analgesia).The primary and secondary outcome indicators in two groups were recorded and compared.The primary outcome indicator was analgesic effect,Visual Analogue Scale(VAS)score for rest and cough 2,6,12,24,and 72 hours after surgery.The secondary outcome indicators included postoperative use of analgesics,postoperative adverse reactions and analgesia satisfaction.Postoperative use of analgesics included the amount of sufentanil used within 24 hours after surgery,the number of effective presses of the analgesia pump and the number of additional rescue analgesia.Adverse reactions during postoperative analgesia included dizziness,lethargy,postoperative nausea and vomiting(PONV),hypotension,urinary retention,etc.Results:The rest and cough VAS scores in Group R were significantly lower than those in Group C 2,6,12,24 and 72 hours after surgery(P<0.05).The dosage of sufentanil,frequency of effective press of analgesia pump and frequency of additional rescue analgesia in group R were significantly lower than those in group C within 24 hours after surgery(P<0.05).The incidences of dizziness and PONV in group R were significantly lower than those in group C(P<0.05).The overall satisfaction over postoperative analgesia in Group R was higher than that in Group C(P<0.05).Conclusion:Ultrasound-guided RISS block can provide good postoperative analgesia for thoracoscopic radical resection of lung cancer,reduce the demand for postoperative analgesic drugs a

关 键 词：超声引导 菱形肌-肋间肌-低位前锯肌平面阻滞 胸腔镜下肺癌根治术 术后镇痛 随机对照研究 

分 类 号：R734.2[医药卫生—肿瘤]