目的 回顾性分析竖脊肌平面阻滞与前锯肌平面阻滞对胸腔镜术后急性疼痛的影响。 方法 选取2018年1月至2018年12月于我院行择期单孔胸腔镜手术患者87例，其中对照组29例（全凭静脉麻醉）、竖脊肌平面阻滞组30例（T5平面阻滞联合全凭静脉麻醉）和前锯肌平面阻滞组28例（T5平面阻滞联合全凭静脉麻醉）。麻醉期间常规监测患者心率、血压、脉搏氧饱和度，分别于术前，术后2 h、8 h、12 h、24 h和48 h对患者进行VAS评分。记录患者术中和术后PCIA阿片类药物消耗情况及术后48 h内恶心呕吐、瘙痒和呼吸抑制等并发症发生情况。 结果 竖脊肌平面和前锯肌平面阻滞组患者VAS评分在术后2 h、8 h、12 h显著低于对照组，而竖脊肌平面阻滞组又低于前锯肌平面组，差异具有统计学意义（P<0.05）。与对照组相比，竖脊肌平面阻滞组和前锯肌平面阻滞组术中和术后PCIA阿片类药物消耗均显著减少，且竖脊肌平面组少于前锯肌平面组，差异具有统计学意义（P<0.05）。 结论 在单孔胸腔镜手术围术期镇痛中，超声引导下竖脊肌平面阻滞较前锯肌平面阻滞具有更好的镇痛效果，减少围术期阿片类药物用量。
Abstract
Objective To retrospectively analyze the effect of erector spinae plane block and serratus anterior plane block on acute pain after single-port thoracoscopic surgery. Methods Eighty-seven patients were selected, who underwent selective thoracoscopic surgery under total intravenous general anesthesia in our hospital from January to December 2018. Twenty-nine patients who only accepted total intravenous general anesthesia were assigned to the control group. The 30 patients who accepted total intravenous general anesthesia (TIVA) combined with erector spinae plane block (ESPB) were assigned to the ESPB group. Twenty-eight patients who accepted TIVA combined with serratus anterior plane block (SAPB) were assigned to SAPB group. All patients accepted patient controlled intravenous analgesia (PCIA) for postoperative analgesia. Heart rate, blood pressure, and pulse oximetry were routinely monitored during anesthesia. VAS scores were obtained before surgery, 2 h, 8 h, 12 h, 24 h, and 48 h after surgery. Opioids consumption during the operation and PCIA were also recorded. Additionally, postoperative complications such as nausea and vomiting, urinary retention, itching and respiratory depression during 48 h after surgery were also recorded. Results VAS scores in the ESPB and SAPB group were significantly lower than those in the control group at 2, 8 and 12 h postoperatively. And the ESPB group was lower than SAPB group (P<0.05). Compared with the control group, the opioids consumption during the operation and PCIA of ESPB and SAPB group were significantly decreased and the ESPB group decreased more than the SAPB group (P<0.05). Conclusion In the perioperative analgesia of thoracoscopic surgery, ultrasound-guided ESPB has better analgesic effect than SAPB, reducing perioperative opioid consumption.
关键词
竖脊肌 /
前锯肌 /
神经阻滞 /
疼痛
Key words
/
Erector spinae /
Serratus anterior /
Nerve block /
Pain
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基金
南方医科大学南方医院院长基金（2014C021）
京ICP备08002354号-3
