急诊室连续竖脊肌平面阻滞对胸部创伤患者疼痛控制及不良反应的影响

目的评价在急诊室实施超声引导下连续竖脊肌平面阻滞对胸部创伤患者围术期疼痛控制及不良反应的影响。方法前瞻性分析2017年12月-2018年11月联勤保障部队第九O九医院心胸外科收治的68例胸创伤急诊患者,男性44例,女性24例;年龄19~73岁,平均45. 8岁;ASA分级Ⅱ~Ⅲ级,AIS评分3~4分;致伤机制:冲击伤49例,挤压伤14例,爆震伤5例。按照随机数字法分为连续竖脊肌平面阻滞复合静脉自控镇痛组(E组,n=34)和静脉自控镇痛组(P组,n=34),记录两组患者注药前(T0)、注药后30min(T1)、麻醉前(T2)、术后12h(T3)、术后24h(T4)、术后48h(T5) VAS评分及围术期不良反应、阿片类药物追加率和使用总量、住院天数、术后慢性疼痛(CPSP)的发生率。结果 E组T1~T5时间点VAS评分显著低于P组(P <0. 05),E组住院期间肺部感染(8. 8%)、肺不张(8. 8%)、恶心呕吐(5. 8%)、术后CPSP发生率分别为20. 5%,显著低于P组(17. 6%、26. 4%、35. 2%、38. 2%,P <0. 05)。E组哌替啶使用率(17. 6%)、使用总量(550mg)与平均住院天数(6. 8±2. 4) d显著低于P组76. 4%、2350mg、(10. 5±1. 1) d,P <0. 05]。结论急诊室超声引导下连续竖脊肌平面阻滞可以明显缓解胸部创伤患者的疼痛,缩短患者住院时间,降低不良反应发生率。

Effects of emergency department continuous erector spinae plane block on pain control and adverse reactions in patients with thoracic trauma

Objective To evaluate the effects of ultrasound-guided continuous erector spinae plane block in emergency room on perioperative pain control and its adverse reactions in patients with thoracic trauma. Methods From Dec. 2017 to Nov. 2018,68 cases of emergency thoracic trauma were admitted to the Cardiothoracic Surgery of the109 th Hospital of the United Logistics Support Force,. There were 44 males and 24 females;with an average age of45. 8 years( range,19-73 years);ASA grades Ⅱ to Ⅲ,with 3-4 points for AIS score;injury mechanisms: 49 cases of impact injury,14 cases of crush injury,and 5 cases of explosion injury. According to the random number method,it was divided into continuous erector spinae plane block combined with patient-controlled intravenous analgesia group( Egroup,n = 34) and intravenous self-controlled analgesia group( P group,n = 34). The Visual Analogue Scale( VAS) score,perioperative adverse reactions,additional rate and total use of opiate drugs,hospitalization days,and the incidence of chronic post-surgical pain( CPSP) of the patients in the two groups were recorded before injection( T0),30 minutes after injection( T1),before anesthesia( T2),12 hours after operation( T3),24 hours after operation( T4),48 hours after operation( T5),respectively. Results The VAS scores at T1-T5 time points in group E were significantly lower than those in group P( P < 0. 05). The incidence rates of pulmonary infection( 8. 8%),atelectasis( 8. 8%),nausea and vomiting( 5. 8%) and chronic post-surgical pain( 20. 5%) in group E were significantly lower than those in group P( 17. 6%,26. 4%,35. 2%,38. 2%,P < 0. 05). The usage rate( 17. 6%),and total usageof meperidine hydrochloride( 550 mg),and average hospitalization days( 6. 8 ± 2. 4) d in group E were significantly lower than those in group P76. 4%,2350,( 10. 5 ± 1. 1) d,P < 0. 05]. Conclusion Ultrasound-guided continuous Erector spinae plane block in emergency room can significantly alleviate the pain of patients with thoracic trauma,and reduce hospitalization time and the incidence rate of adverse reactions.