超声引导下前锯肌浅面和前锯肌深面阻滞在胸腔镜手术镇痛中的研究

目的 对比研究超声引导下前锯肌浅面阻滞(Shallow serratus plane block,SSPB)和前锯肌深面阻滞(Deep serratus plane block,DSPB)在胸腔镜手术中的镇痛效果。方法 选择2019年1月1日～6月20日于余姚市人民医院行择期胸腔镜手术的患者60例,所有患者均为ASA(美国麻醉医师协会)Ⅰ～Ⅱ级,按照随机法平均分为超声引导下SSPB联合静脉自控镇痛泵组(P组)和超声引导下DSPB联合静脉自控镇痛泵组(C组)。P组患者于术前行超声引导下SSPB阻滞,C组患者行超声引导下DSPB阻滞,15 min后测定两组患者的神经阻滞范围,两组患者手术结束后均使用静脉自控镇痛(PCIA)泵镇痛。分别对两组患者术后1 h、6 h、12 h、18 h和24 h的伤口疼痛情况进行视觉模拟(VAS)评分,记录镇痛泵输注总量、患者自控追加按压次数以及术后不良反应发生率。结果15 min后DSPB组阻滞平面可达T3～T8脊神经支配节段,SSPB组阻滞平面可达T2～T9脊神经支配节段;两组静息和咳嗽时VAS评分在术后1 h、6 h、12 h及18 h时均无明显差异(P0.05);两组24 h时VAS评分比较,差异有统计学意义(P0.05);两组术后镇痛泵输注镇痛药物总量、追加按压次数比较,差异无统计学意义(P0.05);两组术后恶心、呕吐、皮肤瘙痒的发生率比较,差异无统计学意义(P0.05)。结论 DSPB联合PCIA泵在胸腔镜术后可发挥良好的镇痛效果。

Study on ultrasound-guided shallow serratus plane block and deep serratus plane block in thoracoscopic surgery analgesia

Objective To compare the studies on ultrasound-guided shallow serratus plane block (SSPB) and deep serratus plane block (DSPB) in thoracoscopic surgery analgesia. Methods Sixty patients treated with elective thoracoscopic surgery with the American Society of Anesthesiologists (ASA) grade I-II from January 1st to June 20th, 2019 were enrolled and divided into the ultrasound-guided SSPB block combined with patient-controlled intravenous analgesia pump group (group P) and the ultrasound-guided DSPB block combined with patient-controlled intravenous analgesia pump group(group C) according to the random method. Group P was given ultrasound-guided SSPB block and group C was given ultrasound-guided DSPB block before surgery.The nerve block range of the two groups was determined 15 minutes later. The patient-controlled intravenous analgesia(PCIA) pump was used in both groups after surgery. Visual analog scale(VAS) was used to evaluate the postoperative wound pain 1 hour, 6 hours, 12 hours and 24 hours after surgery of the two groups. The total infusion amountof analgesic pump, counts of patient-controlled additional compressions and incidences of postoperative adverse reactions were recorded. Results In the DSPB group, the block plane was T3-T8 spinal nerve innervation segments after 15 minutes, and in the SSPB group, the block plane was T2-T9 spinal nerve innervation segments. The two groups were not significantly different in the VAS scores at rest and during cough at 1 hour, 6 hours, 12 hours and 18 hours (P>0.05), while the two groups were statistically different in the VAS score at 24 hours(P<0.05). The two groups were not significantly different in the total analgesic drug infusion amountof analgesic pump and the count of additional compressions(P>0.05). There was no statistically significant differences in postoperative nausea, vomiting, skin itch between the two control groups(P>0.05). Conclusion DSPB plane block combined with PCIA can exert good analgesic effect after thoracoscopic surgery.