超声引导下双侧胸肋间筋膜阻滞在心脏手术中的应用

目的探讨超声引导下胸肋间筋膜(PIF)阻滞对正中开胸心脏手术患者术中及术后镇痛效果的影响。方法择期正中开胸体外循环下行二尖瓣或主动脉瓣置换术的患者60例,ASA分级为Ⅱ~Ⅲ级,随机分为两组:PIF阻滞组和对照组。PIF阻滞组于全麻插管后行超声引导下双侧PIF阻滞,每侧注射0.375%盐酸罗哌卡因20 ml,对照组不阻滞。记录手术切皮前及切皮后5 min两组患者SBP、DBP和HR。两组患者拔除气管导管后均行PCIA。记录拔管后即刻、拔管后4 h、拔管后8 h、术后24 h疼痛VAS评分,Ramsay镇静评分及BCS舒适度评分。记录地佐辛的追加次数。观察并记录有无恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果与对照组相比,PIF阻滞组切皮时BP、HR变化减小(P<0.05);拔管后即刻、拔管后4 h、拔管后8 h,PIF阻滞组VAS评分明显降低,地佐辛追加次数少,BCS舒适度评分明显升高(P<0.05),PIF阻滞组术后拔管更早(P<0.05)。两组患者均未见明显的恶心、呕吐等不良反应。结论超声引导下的PIF阻滞用于开胸心脏手术可减少术中及术后静脉镇痛药的需要量,增强术后镇痛效果,提高患者舒适度。

Ultrasound-guided Transversus Pect-intercostal Fascial Block in Cardiac Surgical Patients

Objective To investigate the effect of ultrasound-guided pect-intercostal fascial(PIF)block on intraoperative and postoperative analgesia in cardiac surgical patients.Methods Sixty patients(ASAⅡorⅢ)scheduled for mitral or aortic valve replacement via median sternotomy were randomly divided into two groups(n=30 each):PIF group and control group.Under ultrasound guidance,patients in PIF group received PIF block with 20 ml of 0.375%ropivacaine bilaterally,while patients in control group did not receive any injection.All blockades were performed by a single anesthesiologist.SBP,DBP and HR of the two groups were recorded before and 5 min after skin incision.Both groups received patient-controlled intravenous analgesia(PCIA)after operation.Visual analogue scale(VAS),Ramsay sedation score and the Bruggrmann comfort scale(BCS)were evaluated at the time of extubation,4 and 8 h after extubation and 24 h after operation.The use frequency of dezocine and adverse reactions were recorded.Results The change rate of BP,HR before and 5 min after skin incision,VAS score and use frequency of dezocine were significantly lower in PIF group than those in control group(P<0.05).There were no adverse reactions in any groups.Conclusion Ultrasound-guided transversus PIF block can reduce the intraoperative and postoperative sufentanil consumption and enhance the efficacy of postoperative analgesia in patients undergoing median thoracotomy.