双侧胸横肌平面阻滞在开胸瓣膜手术中的应用  

Application of bilateral transverse thoracic muscle plane block in open chest cardiac valve surgery

作　　者：宋思明 龚拯[1] 路洋 栗俊[1] 刘小青[1] 王家伟 SONG Siming;GONG Zheng;LU Yang;LI Jun;LIU Xiaoqing;WANG Jiawei(Department of Anesthesiology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530000,Guangxi,China)

机构地区：[1]广西壮族自治区人民医院麻醉科,南宁530000

出　　处：《中国分子心脏病学杂志》2025年第1期6623-6628,共6页Molecular Cardiology of China

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2020083);自治区卫生健康委自筹经费科研课题(Z-A20230141)。

摘　　要：目的 探讨双侧胸横肌平面阻滞对胸骨正中开胸瓣膜置换术的影响。方法 选取广西壮族自治区人民医院择期行正中开胸心脏瓣膜置换术的患者80例,随机分为阻滞组和对照组。阻滞组于全身麻醉插管后行超声引导下双侧胸横肌平面阻滞,每侧注射20 mL的0.4%罗哌卡因注射液。记录两组患者术中血糖、乳酸和术后白细胞、C反应蛋白等情况;记录术后48 h内患者自控镇痛泵按压次数及追加地佐辛的情况;记录术后第1天、第2天、第3天疼痛VAS评分和两组患者术后恢复及不良反应情况。结果 阻滞组患者舒芬太尼用量和苏醒后48 h自控静脉镇痛泵按压次数及需要追加地佐辛的情况均少于对照组(P<0.05);术后3 d,阻滞组患者白细胞水平、安静和活动时VAS评分低于对照组(P均<0.05);阻滞组患者术后在ICU机械通气时间少于对照组(P<0.05)。结论 双侧胸横肌平面阻滞用于胸骨正中开胸心脏瓣膜置换术,可以减少阿片类药物用量,改善术后炎症,减轻术后急性疼痛,有利于术后快速康复。Objective To explore the effect of bilateral transverse thoracic muscle plane block on median open chest cardiac valve replacement. Methods A total of 80 patients were selected for elective median open chest cardiac valve replacement in the People′s Hospital of Guangxi Zhuang Autonomous Region and randomly divided into block group(group T) and control group(group G). Group T underwent ultrasound-guided bilateral transverse thoracic muscle plane block after general anesthesia intubation and each side was injected with 20 mL of 0.4% ropivacaine injection. The changes of intraoperative blood glucose and lactic acid, postoperative leukocytes, and C-reactive protein were recorded in both groups;the number of presses of self-control pain pump and additional dezocine were recorded in the 48 h postoperative period;VAS scores of pain on the 1st, 2nd and 3rd days postoperative were recorded as well as the postoperative recovery and adverse reactions of patients in both groups. Results The dosage of sufentanil, the number of compressions by the self-controlled intravenous pain pump and the number of patients who needed additional dezocine in group T were less than those in group G(P<0.05);the leukocyte level of patients in group T was lower than that of group G in the first three days after surgery(P<0.05);the VAS scores of patients in group T were lower than that of group G in the first three days after surgery(P<0.05);the postoperative mechanical ventilation time of patients in group T in the ICU was less than that of group G(P<0.05). Conclusions Bilateral transverse thoracic muscle plane block for median sternotomy open chest heart valve replacement can reduce the dosage of opioids, improve postoperative inflammation, reduce acute postoperative pain, and facilitate rapid postoperative recovery.

关 键 词：正中开胸 胸横肌平面阻滞 心脏瓣膜置换术 镇痛 术后快速康复 

分 类 号：R614[医药卫生—麻醉学]