超声引导下椎旁神经阻滞与胸横肌平面阻滞在心脏瓣膜置换患者中的应用效果比较

目的 比较超声引导下椎旁神经阻滞与胸横肌平面阻滞在心脏瓣膜置换患者中的应用价值。方法 选择2019年10月至2021年10月于华中阜外医院行心脏瓣膜置换术患者100例为研究对象，将患者随机分为观察组和对照组，每组50例。观察组患者于超声引导下行椎旁神经阻滞，对照组患者于超声引导下行胸横肌平面阻滞，2组患者均于神经阻滞完成后接受全身麻醉。比较2组患者气管插管时(T₁)、劈胸骨时(T₂)、切开心包时(T₃)、关胸时(T₄)的血流动力学指标心率(HR)和平均动脉压(MAP);分别于麻醉苏醒后6 h(T₅)、苏醒后12 h(T₆)、苏醒后24 h(T₇)、苏醒后48 h(T₈)时采用视觉模拟评分法(VAS)评估2组患者的镇痛效果，记录并比较2组患者镇痛药物使用剂量、镇痛泵按压次数及麻醉苏醒后48 h内不良反应发生情况。结果 2组患者T₂、T₃、T₄时的HR...

Comparison of the application effect of ultrasound-guided paravertebral nerve block and transverse pectoral muscle plane block in patients with heart valve replacement

Objective　To compare the application value of ultrasound-guided paravertebral nerve block and transverse pectoral muscle plane block in patients with heart valve replacement.Methods　A total of 100 patients with heart valve replacement admitted to Huazhong Fuwai Hospital from October 2019 to October 2021 were selected as the study subjects.The patients were randomly divided into observation group and control group,with 50 cases in each group.The patients in the observation group received paravertebral nerve block under ultrasound guidance,and the patients in the control group received transverse pectoral muscle plane block under ultrasound guidance.The patients in both groups received general anesthesia after completing the nerve block.The hemodynamic indexes of heart rate (HR) and mean arterial pressure (MAP) were compared between the two groups at the time points of tracheal intubation (T₁),osteotomy (T₂),pericardiectomy (T₃) and chest closure (T₄).The analgesic effect of patients in the two groups were evaluated by visual analogue scale (VAS) at the time points of 6 h (T₅),12 h (T₆),24 h (T₇) and 48 h (T₈) after awakening from anesthesia;the analgesic drug dosage,the times of pressing the analgesic pump and the adverse reactions within 48 hours after recovery from anesthesia were recorded and compared between the two groups.Results　The HR and MAP of patients at T₂,T₃ and T₄ were significantly lower than those at T₁ in the two groups(P<0.05);the HR and MAP of patients at T₃,T₄ were significantly lower than those at T₂ in the two groups(P<0.05);the HR and MAP of patients at T₄ were significantly lower than those at T₃ in the control group(P<0.05);the HR of patients at T₄ was significantly lower than that at T₃ in the observation group(P<0.05);there was no significant difference in MAP between T₄ and T₃ time points in the observation group (P>0.05).There was no significant difference in HR and MAP of patients between the two groups at T₁ (P>0.05);the HR and MAP of patients in the observation group were significantly higher than those in the control group at T₂,T₃ and T₄ time points (P<0.05).There was no significant difference in VAS scores of patients between the observation group and the control group at T₅ time point (P>0.05)；the VAS scores of patients in the control group were significantly higher than those in the observation group at T₆-T₈ time points (P<0.05).The VAS scores of patients in the two groups showed an upward trend at T₅-T₈,and there was significant difference between any two time points(P<0.05).The dosage of analgesic drugs and the the times of pressing the analgesic pump of patients in the observation group were significantly less than those in the control group (P<0.05).The total incidence of adverse reactions of patients in the observation group and the control group was 6% (3/50) and 10% (5/50),respectively;there was no significant difference in the total incidence of adverse reactions between the two groups（χ²=0.136，P>0.05）.Conclusion　In heart valve replacement surgery,compared with transverse pectoral muscle plane block,the ultrasound-guided paravertebral nerve block can better maintain hemodynamic stability,reduce postoperative pain,reduce the dosage of analgesic drugs and the times of pressing the analgesic pump.