前锯肌平面阻滞促进腋乳入路机器人辅助甲状腺手术患者的快速康复(附手术视频)  

Serratus anterior plane block facilitates enhanced recovery in patients undergoing robot-assisted thyroidectomy via the axillo-breast approach(with surgical video)

作　　者：张伟 王飞 高成杰 ZHANG Wei;WANG Fei;GAO Chengjie(The Anesthesiology College of Shandong Second Medical University,Weifang 261053,China;Department of Anesthesiology,the 960th Hospital of PLA Joint Logistic Support Force,Jinan 250031,China)

机构地区：[1]山东第二医科大学麻醉学院,山东潍坊261053 [2]中国人民解放军联勤保障部队第九六〇医院麻醉科,山东济南250031

出　　处：《机器人外科学杂志(中英文)》2025年第4期585-590,共6页Chinese Journal of Robotic Surgery

基　　金：济南市科学技术局临床医学科技创新计划(202019018)。

摘　　要：目的:研究前锯肌平面阻滞(SAPB)在经双侧腋窝乳晕入路(BABA)达芬奇机器人辅助甲状腺手术中的临床价值。方法:选择2022年2月—2022年5月于本院择期行BABA入路机器人辅助甲状腺手术70例患者为研究对象。利用随机数字表法分为GS组(静脉全身麻醉复合SAPB)和G组(静脉全身麻醉),每组35例。记录两组患者切皮前(T0)、Trocar置入(T1)、手术腔道冲洗(T2)和拔管后5 min(T3)四个时点的MAP、HR,记录两组患者术中舒芬太尼、丙泊酚、瑞芬太尼用量及术毕苏醒拔管时间。记录两组患者术后2 h、6 h、12 h、24 h、48 h五个时间点疼痛数字评分(NRS)以及不良反应发生状况。结果:两组患者T0、T1、T2、T3四个不同时点MAP差异均无统计学意义(P>0.05);两组患者HR比较,T0、T1时差异无统计学意义(P>0.05),T2、T3时GS组明显低于G组(P<0.05)。与G组相比,GS组术中舒芬太尼、丙泊酚及瑞芬太尼用量明显减少(P<0.05),术毕苏醒拔管时间缩短(P<0.05),术后2 h、6 h、12 h、24 h、48 h NRS评分明显降低(P<0.05)。两组患者术后不良反应状况类似(P>0.05)。结论:全身麻醉联合SAPB可以降低BABA入路机器人辅助甲状腺手术患者术中手术腔道冲洗及苏醒后的HR,减轻患者应激反应,减少术中阿片类药物及镇静药物用量,降低患者术后疼痛评分,提高患者舒适度,且无相关并发症及不良反应,可为患者带来较好的临床效果,值得临床推广。Objective:To evaluate the clinical efficacy of serratus anterior plane block(SAPB)in patients undergoing Da Vinci robotassisted thyroidectomy via the bilateral axillo-breast approach(BABA).Methods:70 patients scheduled for robot-assisted thyroidectomy via BABA from February 2022 to May 2022 were enrolled.They were divided into the GS group(n=35,receiving general anesthesia combined with SAPB)and the G group(n=35,receiving general anesthesia alone)using a random number table.Mean arterial pressure(MAP)and heart rate(HR)were recorded at 4 timepoints:pre-incision(T0),Trocar placement(T1),surgical cavity irrigation(T2),and 5 minutes after extubation(T3).Intraoperative consumption of sufentanil,propofol,and remifentanil,as well as extubation time,were recorded.Postoperative Numerical Rating Scale(NRS)scores and adverse events were assessed at 2,6,12,24,and 48 hours after surgery.Results:No significant differences in MAP were observed between the two groups at any timepoint(P>0.05).HR in the GS group was significantly lower than the G group at T2 and T3,but there was no significant difference at T0 and T1 between the two groups(P<0.05).The GS group required significantly lower doses of sufentanil,propofol,and remifentanil(P<0.05),shorter extubation time(P<0.05),lower NRS scores at 2,6,12,24,and 48 hours after surgery than the G group(P<0.05).Rates of adverse event were comparable between the two groups(P>0.05).Conclusion:General anesthesia combined with SAPB can lower HR,alleviate stress response,reduce opioid and sedative requirements,reduce postoperative pain scores,and improve patient comfort levels in patients undergoing robot-assisted thyroidectomy via BABA without increasing block-related complications,which is worth of clinical promotion.

关 键 词：前锯肌平面阻滞 超声引导 手术机器人 甲状腺手术 罗哌卡因 

分 类 号：R614.27[医药卫生—麻醉学]