超声引导前锯肌平面阻滞在胸腔镜手术围术期麻醉和镇痛中的临床应用

目的 探讨超声引导下前锯肌平面阻滞(SP)在胸腔镜手术麻醉及术后镇痛中的临床应用价值。方法 选择2016年8月—2017年10月在上海交通大学附属第六人民医院金山分院择期行胸腔镜肺叶楔形或肺段切除手术的40例患者进行前瞻性研究。40例患者采用随机数字表法分为观察组和对照组,每组20例。观察组采用SP复合全身麻醉,对照组采用全身麻醉。观察组术前30 min行超声引导术侧SP,注入0.5 % 盐酸罗哌卡因20 mL。术后均行患者自控静脉镇痛。记录2组患者入手术室麻醉前、切皮后5 min、拔管前即刻的平均动脉压(MAP)、心率(HR),术后 2、6、12、24、48 h 患者静息状态及咳嗽时疼痛视觉模拟评分(VAS),术中丙泊酚、舒芬太尼用量,镇痛泵有效按压次数(D₁)和实际按压次数(D₂)并计算D₁/D₂值;观察术后有无SP相关并发症发生。结果 与对照组比较,观察组切皮后5 min、拔管前即刻MAP低、心率慢,差异均有统计学意义(P值均＜0.05)。观察组和对照组患者术后2、6、12 h 静息状态VAS分别为(2.0±0.6)分、(2.0±0.8)分、(3.3±1.2)分和 (4.3±1.5 ) 分、(4.6±2.1)分、(4.5±1.9)分,咳嗽时分别为(2.1±0.5) 分、(2.1±0.8)分、(3.7±1.4) 分和(4.6±2.4) 分、(4.8±2.2)分、(5.0±1.8)分,观察组均低于对照组,差异均有统计学意义(P值均＜0.05)。观察组和对照组术中丙泊酚用量分别为(231±42) mg和(412±58) mg,舒芬太尼用量分别为(35±5.6) μg和( 52±6.8) μg,D₁/D₂值分别为0.89±0.12和0.55±0.11,差异均有统计学意义(P值均＜0.01)。观察组患者在超声引导下顺利完成SP,未见穿刺相关并发症。结论 超声引导行SP能有效减轻患者胸腔镜手术后早期急性疼痛,减少术中、术后镇痛药的用量,具有较高的临床应用价值,建议临床推广应用。

Effect of ultrasound-guided serratus plane block on efficacy of anesthesia and postoperative analgesia in patients undergoing video-assisted thoracoscopy

Objective To investigate the effect of ultrasound-guided serratus plane block (SP) after video-assisted thoracoscopy.Methods Forty patients of being scheduled for selected video-assisted thoracoscopy operation in the Jinshan Sub-Hospital of No.6 Hospital Affiliated to Shanghai Jiao Tong University from August 2016 to October 2017 were prospectively randomized to observation group and control group, 20 patients in each group: SP combined with general anesthesia group (observation group) and general anesthesia group (control group). Patients in observation group received serratus plane injection 20 mL of 0.5% ropivacaine hydrochloride under ultrasound guide 30 min before the surgery. The patients in both groups were received patient-controlled intravenous analgesia after operation. Mean artery pressure (MAP) and heart rate (HR) were recorded at the patients was brought to the operation room rest, 5 min after skin incision and immediately before extubation. visual analgesia scores (VAS) were recorded at 2, 6, 12, 24 and 48 h after operation whenever at rest or during cough. The consumption of propofol and sufentanil during operation were recorded. Meantime, the times of successfully delivered doses (D₁) and attempts (D₂) within 24 h after operation were added up, calculating D₁/D₂. The related complications were recorded as well.Results Compared with control group at 5 min after skin incision and immediately before extubation, MAP was significantly lower, HR were significantly decreased in observation group, there were statistical differences (all P values＜0.05). The VAS at 2, 6 and 12 h after operation both at rest [(2.0±0.6) point,(2.0±0.8)point,(3.3±1.2)point vs. (4.3±1.5) point,(4.6±2.1)point,(4.5±1.9)point] and coughing [(2.1±0.5) point,(2.1±0.8)point,(3.7±1.4) point vs. (4.6±2.4) point, (4.8±2.2) point, (5.0±1.8)point] in observation group was significantly lower than that in control group, there were statistical differences (all P values＜0.05). Propofol consumption [(231±42) mg vs.(412±58) mg] and sufentanil consumption [(35±5.6) μg vs.( 52±6.8) μg] were significantly less in observation group than those in control group, while D₁/D₂ (0.89±0.12 vs. 0.55±0.11)was higher, there were statistical differences (all P values＜0.01). SP was accomplished in observation group without puncture-related complications.Conclusions Ultrasound-guided SP during video-assisted thoracoscopy effectively reduces the pain and the dosage of intraoperative and postoperative analgesics.