摘要
目的探讨超声引导下腋后线前锯肌平面(Serratus Plane,SP)阻滞在胸腔镜肺叶切除术中的应用。方法方便选取2016年1月—2017年8月在兰陵县人民医院择期进行电视辅助胸腔镜肺叶切除术的患者120例,随机分为两组:腋后线前锯肌阻滞组(SP组)和对照组(C组),每组60例患者。于麻醉诱导后行超声引导下术侧SP阻滞,SP组注射0.375%罗哌卡因20 mL,C组注射等体积生理盐水。记录术后自控镇痛使用舒芬太尼的累计追加用量。对患者进行术后随访,分别对其术后平静状态和活动状态时伤口疼痛情况进行视觉模拟评分,即VAS评分。呼吸循环功能监测患者的呼吸功能,记录术毕后4 h两组患者的呼吸频率、潮气量、分钟通气量及最大通气量。观察并记录患者术后有无皮肤瘙痒、恶心、呕吐等不良症状的发生。观察患者术后有无肋间神经阻滞引起的并发症。结果与对照组相比,SP阻滞研究组VAS疼痛评分在术后4 h [(0.9±0.7)分vs (3.1±1.5)分],24 h [(1.3±1.5)分vs (2.5±1.7)分],VAS评分均明显降低,差异有统计学意义(t=2.060、2.071,P<0.05);术后舒芬太尼累积追加用量12 h [(13.3±1.9)μg vs (21.2±2.4)μg],24 h[(26.7±2.1)μg vs (35.3±3.2)μg],累计追加剂量明显减少,差异有统计学意义(t=2.064、2.715,P<0.05)。同时SP组患者因疼痛减轻术后4 h的呼吸频率[(16±2)bpm vs (20±3)bpm],分钟通气量[(5 345±419)mL/min vs (4 121±388)mL/min],呼吸功能比对照组有明显改善,差异有统计学意义(t=2.060、2.177,P<0.05)。两组患者均未见严重并发症。结论超声引导腋后线前锯肌阻滞能减轻胸腔镜肺叶切除术患者术后24 h内的急性疼痛,并且能减少静脉自控镇痛阿片类药物的累积用量,增加分钟通气量,减少术后呼吸系统并发症。
Objective To investigate the application of ultrasound-guided serratus Plane （SP） block in thoracoscopic lobectomy. Methods A total of 120 patients who underwent video-assisted thoracoscopic lobectomy in Lanling County People＇s Hospital from January 2016 to August 2017 were randomly divided into two groups conveniently： anterior sacral muscle block （SP group） and the control group （group C）, each group of 60 patients. After induction of anesthesia, ultrasound-guided SP block was performed, and SP group was injected with 0.375% ropivacaine 20 mL. Group C was injected with an equal volume of normal saline. The cumulative additional dose of sufentanil was recorded for postoperative controlled analgesia. The patients were followed up for a visual analog score, ie, VAS score, for the postoperative calm state and wound state of the wound. The respiratory cycle function was used to monitor the patient＇s respiratory function, and the respiratory rate, tidal volume, minute ventilation, and maximum ventilation of the two groups were recorded 4 hours after surgery. Observe and record the patient＇s postoperative symptoms such as itching, nausea, vomiting and other adverse symptoms. Observe the complications of the patients with or without intercostal nerve block. Results Compared with the control group, the VAS pain score of the SP block study group was 4 h after surgery [（0.9±0.7）points vs （3.1±1.5）points], 24 h [（1.3±1.5）points vs （2.5 ± 1.7）points], VAS scores were significantly reduced （t =2.060,2.071, P〈0.05 ） ; postoperative sufentanil cumulative dose 12 h[（13.3±1.9）lzg vs （21.2±2.4）μg], 24 h [（26.7±2.1）μg vs （35.3±3.2）μg], the cumulative additional dose was significantly reduced （t=2.064,2.715 ,P〈0.05）. At the same time, the respiratory rate of the patients in the SP group was reduced by 4 hours after surgery [（16±2）bpm vs （20±3）bpm], minute ventilation [（5 345±419）mL/min vs （4 121±388）mL/min], the respira- tory function was significantly improved compared with the control group, and the difference were statistically significant （t= 2.060,2.177,P〈0.05）. No serious complications were seen in either group. Conclusion Ultrasound-guided anterior sacral muscle block can reduce acute pain within 24 hours after thoracoscopic lobectomy, and can reduce the cumulative dose of intravenous analgesia opioids, increase minute ventilation, and reduce postoperative respiration and systemic complications.
作者
张明东
张文杰
师敬利
潘立凤
王磊
ZHANG Ming-dong;ZHANG Wen-fie;SHI Jing-li;PAN Li-feng;WANG Lei(Department of Anesthesiology,Lanling County People＇s Hospital,Linyi,Shandong Province,277799 China)
出处
《中外医疗》
2018年第27期81-83,86,共4页
China & Foreign Medical Treatment
