摘要
目的 观察前锯肌平面阻滞（SAPB）对胸腔镜手术术后镇痛的效果.方法 选择2017年10月至2018年4月择期接受全身麻醉下胸腔镜肺癌根治术的患者60例,采用随机数字表法将患者分为SAPB组（30例）及对照组（30例）,全身麻醉诱导后经超声引导施行术侧SAPB,SAPB组注射0.5％的罗哌卡因20 ml,对照组注射等量0.9％氯化钠注射液,术后两组均配制静脉镇疼泵.分别于术后1、2、4、8、12、24和48 h行视觉模拟评分（VAS）和舒适度评分（BCS）,同时记录不良反应的发生情况.记录术中瑞芬太尼和术后48 h内额外镇痛药需求量.结果 SAPB组的VAS在术后1、2、4、8和12 h均低于对照组[1 h：（2.70±0.92）分比（5.10±2.04）分、2 h：（2.80±1.00）分比（5.13±1.78）分、4 h：（3.07±1.17）分比（4.93±1.53）分、8 h：（3.13±1.07）分比（4.63±1.47）分、12 h：（2.87±0.73）分比（3.83±1.29）分]（P〈0.05）;SAPB组的BCS在术后1、2、4、8和12 h优于对照组[1 h：（1.90±0.66）分比（0.93±0.91）分 、2 h：（2.03±0.41）分比（0.90±0.80）分、4 h：（1.90±0.40）分比（1.07±0.69）分、8 h：（1.97±0.32）分比（1.20±0.66）分、12 h：（2.03±0.18）分比（1.73±0.45）分],差异有统计学意义（P〈0.05）;且SAPB组术中瑞芬太尼用量及48 h内额外镇痛药需求量均明显少于对照组[（0.23±0.03）mg比（0.34±0.03）mg、（26.67±25.37）mg比（40.00±24.21）mg],差异有统计学意义（P〈0.05）;两组不良反应发生率比较差异无统计学意义（P〉0.05）.结论 SAPB可减轻胸腔镜肺癌根治术患者术后早期疼痛,提高患者的舒适度,加强术后镇痛的效果并减少术后止疼药的使用量.
Objective To investigate the effect of ultrasound-guided serratus plane block （SAPB） on efficacy of postoperative analgesia in patients undergoing video- assisted thoracoscopic surgery. Methods Sixty patients scheduled for video- assisted thoracoscopic radical resection of lung cancer under general anesthesia from October 2017 to April 2018 were divided into 2 groups by random digits table method with 30 cases each： SAPB group and control group. After induction of anesthesia, ultrasound-guided homolateral SAPB was performed, and 0.5% ropivacaine 20 ml was injected in SAPB group, while the equal volume of normal saline was used instead in control group. The patients received intravenous analgesia after operation in 2 groups. The scores of visual analogue score （VAS） and Bruggrmann comfort score （BCS） were evaluated at 1, 2, 4, 6, 12, 24 and 48 h after operation. The consumption of additional pain medication within 48 h after operation and remifentanil during operation were recorded. The adverse effects were also recorded. Results The VAS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly lower than those in control group： （2.70 ± 0.92） scores vs. （5.10 ± 2.04） scores, （2.80 ± 1.00） scores vs. （5.13 ± 1.78） scores, （3.07 ± 1.17） scores vs. （4.93 ± 1.53） scores, （3.13 ± 1.07） scores vs. （4.63 ± 1.47） scores and （2.87 ± 0.73） scores vs. （3.83 ± 1.29） scores, P 〈0.05; the BCS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly better than those in control group： （1.90 ± 0.66） scores vs. （0.93 ± 0.91） scores, （2.03 ± 0.41） scores vs. （0.90 ± 0.80） scores, （1.90 ± 0.40） scores vs. （1.07 ± 0.69） scores, （1.97 ± 0.32） vs. （1.20 ± 0.66） scores and （2.03 ± 0.18） scores vs. （1.73 ± 0.45） scores, and there were statistical differences （P〈0.05）. The dose of remifentanil consumption of additional pain medication within 48 h in SAPB group were significantly lower than those in control group： （0.23 ± 0.03） mg vs. （0.34 ± 0.03） mg and （26.67 ± 25.37） mg vs. （40.00 ± 24.21） mg, and there were statistical differences （P〈0.05）. There was no significant difference in the incidence of adverse reactions between 2 groups （P 〉 0.05）. Conclusions The SAPB can reduce the early pain after video-assisted thoracoscopic radical resection of lung cancer, improve the comfort of patients, enhance the effect of postoperative analgesia and reduce the use of postoperative analgesic drugs.
作者
商丽华
肖甄男
龙波
Shang Lihua;Xiao Zhennan;Long Bo(Department of Anesthesia,Shengjing Hospital,China Medical University,Shenyang 110004,China)
出处
《中国医师进修杂志》
2018年第9期819-822,共4页
Chinese Journal of Postgraduates of Medicine
关键词
肺肿瘤
胸腔镜
神经肌肉阻滞
镇痛
超声检查
Lung neoplasms
Video-assisted thoracoscopic surgery
Neuromuscular blockade
Analgesia
Uhrasonography
