摘要
目的观察超声引导下前锯肌平面阻滞(SAPB)对肋骨骨折切开复位内固定术后镇痛及早期康复的影响。方法50例行切开复位内固定术的肋骨骨折患者,按照随机数字表法分为全身麻醉复合SAPB组(S组)和单纯全身麻醉组(G组),每组各25例,G组有1例患者由于病情严重转入ICU而退出研究。S组25例,在全身麻醉前行患侧超声引导下SAPB,G组24例患者不行SAPB,术后均使用静脉自控镇痛(PCIA)泵。记录S组患者的阻滞平面,比较两组患者术后1、6、12、24 h静息及咳嗽时的VAS疼痛强度评分,术后24 hQoR-15评分、镇痛泵按压次数、芬太尼用量及追加药物总量,观察比较穿刺相关并发症、术后不良反应的发生情况。结果S组患者术后1、6、12 h静息和咳嗷时的VAS评分均明显低于G组,差异有统计学意义(P<0.05)。S组和G组术后24h静息时的VAS评分比较,差异无统计学意义(P>0.05)。S组患者术后24h咳嗽时的VAS评分低于G组,差异有统计学意义(P<0.05)。S组患者的QoR-15评分明显高于G组,差异有统计学意义(P<0.05)。S组的芬太尼用量、镇痛泵的按压次数和追加氟比洛芬酯总量均明显少于G组,差异有统计学意义(P<0.05)。S组患者均未出现血肿、气胸、局麻药过敏或中毒等SAPB相关并发症。S组恶心、呕吐的发生率明显低于G组,差异有统计学意义(P<0.05)。结论超声引导下前锯肌平面阻滞可以明显降低肋骨切开复位内固定术后患者的疼痛程度,降低术后镇痛药物的用量,减少不良反应的发生,有利于术后的康复。
Objective To observe the effect of ultrasound-guided serratus anterior plane block(SAPB)on postoperative analgesia and early rehabilitation of patients with rib fracture treated by open reduction and internal fixation.Methods 50 patients with open reduction and internal fixation of rib fracture in our hospital were randomly divided into two groups,general anesthesia combined with SAPB group(group S)and simple general anesthesia group(group G),with 25 patients in each group.One patient in group G was withdrawn from the study due to serious condition transferred to ICU.25 patients in group S received ultrasound-guided SAPB before general anesthesia,while 24 patients in group G did not receive,and patients in both groups were treated with patient-controlled intravenous analgesia(PCIA)after operarion.The block level of patients in group S was recorded,and the VAS score at rest or cough at 1,6,12 and 24 h after operation,the postoperative QoR-15 score at 24 h,the times of analgesic pump pressing,the dosage of fentanyl and the total amount of additional drugs were recorded,and the complications related to puncture and postoperative adverse reactions were observed.Results The VAS scores at rest and cough at 1,6 and 12 h after operation in group S were significantly lower than those in group G,with statistical significance(P<0.05).There was no statistically significant difference between group S and group G of VAS score at rest at 24 h(P>0.05).The VAS score of 24 h at cough in group S was lower than that in group G,and the difference was statistically sigiiificant(P<0.05).The QoR-15 score in group S was significantly higher than that in group G,and the difference was statistically significant(P<0.05).The dosage of fentanyl,the pressing times of analgesic pump and the total amount of flurbiprofen axetil in group S were significantly lower than those in group G,with statistical significance(P<0.05).No SAPB-related complications such as hematoma,pneumothorax,local anesthetic allergy or poisoning occurred in group S.The incidence of nausea and vomiting in group S was significantly lower than that in group G,with statistical significance(P<0.05).Conclusion Ultrasound-guided serratus anterior plane block can significantly reduce the degree of pain after open reduction and internal fixation of rib fractures,reduce the dosage of analgesics and reduce the occurrence of adverse reactions,and it is beneficial to the recovery of patients after operation.
出处
《浙江临床医学》
2022年第2期276-278,共3页
Zhejiang Clinical Medical Journal
关键词
超声引导
前锯肌平面
肋骨骨折
术后镇痛
Ultrasound-guided
Serratus anterior plane
Rib fracture
Postoperative analgesia
