摘要
目的对比研究超声引导下前锯肌浅面阻滞(Shallow serratus plane block,SSPB)和前锯肌深面阻滞(Deep serratus plane block,DSPB)在胸腔镜手术中的镇痛效果。方法选择2019年1月1日~6月20日于余姚市人民医院行择期胸腔镜手术的患者60例,所有患者均为ASA(美国麻醉医师协会)Ⅰ~Ⅱ级,按照随机法平均分为超声引导下SSPB联合静脉自控镇痛泵组(P组)和超声引导下DSPB联合静脉自控镇痛泵组(C组)。P组患者于术前行超声引导下SSPB阻滞,C组患者行超声引导下DSPB阻滞,15 min后测定两组患者的神经阻滞范围,两组患者手术结束后均使用静脉自控镇痛(PCIA)泵镇痛。分别对两组患者术后1 h、6 h、12 h、18 h和24 h的伤口疼痛情况进行视觉模拟(VAS)评分,记录镇痛泵输注总量、患者自控追加按压次数以及术后不良反应发生率。结果15 min后DSPB组阻滞平面可达T3~T8脊神经支配节段,SSPB组阻滞平面可达T2~T9脊神经支配节段;两组静息和咳嗽时VAS评分在术后1 h、6 h、12 h及18 h时均无明显差异(P>0.05);两组24 h时VAS评分比较,差异有统计学意义(P<0.05);两组术后镇痛泵输注镇痛药物总量、追加按压次数比较,差异无统计学意义(P>0.05);两组术后恶心、呕吐、皮肤瘙痒的发生率比较,差异无统计学意义(P>0.05)。结论DSPB联合PCIA泵在胸腔镜术后可发挥良好的镇痛效果。
Objective To compare the studies on ultrasound-guided shallow serratus plane block(SSPB)and deep serratus plane block(DSPB)in thoracoscopic surgery analgesia.Methods Sixty patients treated with elective thoracoscopic surgery with the American Society of Anesthesiologists(ASA)grade I-II from January 1st to June 20th,2019 were enrolled and divided into the ultrasound-guided SSPB block combined with patient-controlled intravenous analgesia pump group(group P)and the ultrasound-guided DSPB block combined with patient-controlled intravenous analgesia pump group(group C)according to the random method.Group P was given ultrasound-guided SSPB block and group C was given ultrasound-guided DSPB block before surgery.The nerve block range of the two groups was determined 15 minutes later.The patient-controlled intravenous analgesia(PCIA)pump was used in both groups after surgery.Visual analog scale(VAS)was used to evaluate the postoperative wound pain 1 hour,6 hours,12 hours and 24 hours after surgery of the two groups.The total infusion amountof analgesic pump,counts of patient-controlled additional compressions and incidences of postoperative adverse reactions were recorded.Results In the DSPB group,the block plane was T3-T8 spinal nerve innervation segments after 15 minutes,and in the SSPB group,the block plane was T2-T9 spinal nerve innervation segments.The two groups were not significantly different in the VAS scores at rest and during cough at 1 hour,6 hours,12 hours and 18 hours(P>0.05),while the two groups were statistically different in the VAS score at 24 hours(P<0.05).The two groups were not significantly different in the total analgesic drug infusion amountof analgesic pump and the count of additional compressions(P>0.05).There was no statistically significant differences in postoperative nausea,vomiting,skin itch between the two control groups(P>0.05).Conclusion DSPB plane block combined with PCIA can exert good analgesic effect after thoracoscopic surgery.
作者
费莉
杨建兵
王浩杰
FEI Li;YANG Jianbing;WANG Haojie(Yuyao People's Hospital in Zhejiang Province,Yuyao 315400,China)
出处
《中国现代医生》
2020年第20期124-127,F0003,共5页
China Modern Doctor
基金
浙江省宁波市医学科技计划项目(2017A53)
浙江省余姚市人民医院院级课(2018YB10)。
