前锯肌平面阻滞联合胸椎旁阻滞在胸腔镜下肺癌根治术中的应用效果  

Effect of Anterior Serratus Plane Block Combined with ThoracicParavertebral Block in Thoracoscopic Radical Resection of Lung Cancer

作　　者：李曼[1] 张树峰 袁莉 朱红霞[1] LI Man;ZHANG Shu-feng;YUAN Li;ZHU Hong-xia(Department of Anesthesiology,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Anesthesiology,Beijing General Hospital of Chinese People’s Armed Police Force,Chaoyang,Beijing 100027,China;Department of Anesthesiology,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第二医院麻醉科,河北张家口075100 [2]中国人民武装警察部队北京市总队医院麻醉科,北京朝阳100027 [3]河北北方学院附属第一医院麻醉科,河北张家口075000

出　　处：《河北北方学院学报(自然科学版)》2025年第6期10-13,18,共5页Journal of Hebei North University:Natural Science Edition

基　　金：河北省卫生健康委科研基金(No.20220579)。

摘　　要：目的 探讨前锯肌平面阻滞联合胸椎旁神经阻滞在胸腔镜下肺癌根治术术中、术后镇痛效果。方法60例拟行胸腔镜肺癌根治术的患者按随机数字表发分为单点胸椎旁神经阻滞组(C组)和前锯肌联合单点胸椎旁神经阻滞组(ST组)各30例。C组患者行单点胸椎旁神经阻滞,ST组患者行单点胸椎旁神经阻滞+前锯肌平面阻滞。手术后配置相同配比的静脉自控镇痛泵。观察手术切皮前(T_(1))、切皮时(T_(2))、切皮后10 min(T_(3))、切皮后30 min(T_(4))、手术结束时(T_5)的心率(HR)和平均动脉压(MAP);统计全身麻醉药物丙泊酚和瑞芬太尼应用剂量;镇痛泵的总有效按压次数(D_(1))、镇痛泵的实际按压次数(D_(2))和D_(1)/D_(2);术后6、12、24 h静息及咳嗽状态下行VAS评分;观察穿刺相关并发症。结果 ST组T_(2)、T_5时HR、MAP低于C组(P<0.05);D_(1)、D_(2)低于C组(P<0.05),D_(1)/D_(2)高于C组(P<0.05);术后6、12 h静息及咳嗽状态下VAS评分低于C组。2组患者穿刺均未出现气胸、血肿、感染等并发症。结论 前锯肌平面阻滞联合单点胸椎旁阻滞可为胸腔镜肺癌根治术术中提供有效镇痛,且术后镇痛效果良好,优于单纯胸椎旁神经阻滞。Objective To investigate the analgesic effect of serratus anterior plane block combined with thoracic paravertebral nerve block in thoracoscopic radical resection of lung cancer.Methods A total of 60 patients undergoing thoracoscopic radical resection of lung cancer were randomly divided into single point thoracic paravertebral nerve block group(group C)and anterior serratus muscle combined with single point thoracic paravertebral nerve block group(group ST),with 30 cases in each group.Patients in group C underwent single-point thoracic paravertebral nerve block,and patients in group ST underwent single-point thoracic paravertebral nerve block+serratus anterior plane block.After the operation,the same ratio of intravenous self-controlled analgesia pump was configured.The heart rate(HR)and mean arterial pressure(MAP)were observed before skin incision(T_(1)),skin incision(T_(2)),10 min after skin incision(T_(3)),30 min after skin incision(T_(4))and at the end of operation(T 5).The doses of propofol and remifentanil for general anesthesia were counted.The total effective pressing times of analgesia pump(D_(1)),the actual pressing times of analgesia pump(D_(2))and D_(1)/D_(2);the VAS scores were recorded at 6,12 and 24 h after operation in resting and coughing state.Observe puncture-related complications.Results HR and MAP at T_(2) and T 5 in group ST were lower than those in group C(P<0.05).D_(1) and D_(2) in group ST were lower than those in group C(P<0.05),and D_(1)/D_(2) was higher than that in group C(P<0.05).The VAS scores of resting and coughing states in ST group were lower than those in C group at 6 and 12 hours after operation.There were no complications such as pneumothorax,hematoma and infection in the two groups.Conclusion Anterior serratus plane block combined with single-point thoracic paravertebral block can provide effective analgesia for thoracoscopic radical resection of lung cancer,and provide more perfect analgesic effect after operation,which is superior to simple thoracic paravertebral block.

关 键 词：前锯肌平面阻滞 胸椎旁神经阻滞 胸腔镜手术 肺癌 

分 类 号：R734.2[医药卫生—肿瘤] R614.2[医药卫生—临床医学]