摘要
目的 探讨超声引导下前锯平面肌(SAPB)联合肋间神经阻滞(ICNB)对胸腔镜下肺切除术后急性疼痛、麻醉药用量及肺功能的影响。方法 将2020年8月至2021年10月沧州市人民医院收治的100例拟行胸腔镜下肺切除术患者纳入本次前瞻性研究,按照随机数字表法将其分为联合阻滞组(n=50)和ICNB组(n=50)。联合阻滞组患者接受超声引导下SAPB+ICNB,ICNB组接受超声引导下ICNB。比较两组围术期相关指标[手术时间、麻醉持续时间、总出血量、麻醉后恢复室(PACU)时间、下床时间和住院时间]、术后不同时间点静息及咳嗽时的视觉模拟评分(VAS)、术中及术后麻醉药用量、术前及术后肺功能指标[第1秒用力呼气容积(FEV1)、FEV1占用力肺活量百分比(FEV1/FVC)、每分最大通气量(MVV)]和不良反应发生情况。结果 两组的手术时间、麻醉持续时间、总出血量、PACU时间和住院时间比较,差异均无统计学意义(P>0.05);联合阻滞组的下床时间为(25.61±3.04) h,显著短于ICNB组[(31.64±3.48) h],差异有统计学意义(P<0.05)。联合阻滞组术后2、4、8、12、24 h静息时VAS评分分别为(2.24±0.81)、(2.68±0.79)、(2.19±0.80)、(1.68±0.52)、(1.09±0.33)分,咳嗽时VAS评分分别为(3.78±0.98)、(3.88±1.06)、(3.09±0.67)、(1.96±0.43)、(1.59±0.38)分,显著低于ICNB组相同时间点的VAS评分[静息时:(3.41±0.94)、(3.89±0.94)、(3.40±0.92)、(2.44±0.58)、(2.05±0.29)分,咳嗽时:(4.67±0.91)、(4.56±1.09)、(4.15±0.62)、(2.99±0.60)、(2.53±0.44)分],差异均有统计学意义(P<0.05)。联合阻滞术中丙泊酚及瑞芬太尼用量、术后24 h和48 h舒芬太尼用量和48 h镇痛泵按压次数分别为(360.85±81.64) mg、(1.29±0.38) mg、(27.45±5.73) mg、(65.40±10.07) mg和(6.85±2.34)次,均显著少于ICNB组[(398.47±90.12) mg、(1.56±0.32) mg、(34.83±5.28) mg、(69.65±9.42) mg和(8.91±2.51)次],差异均有统计学意义(P<0.05)。联合阻滞组术后FEV1、FEV1/FVC、MVV分别为(2.19±0.36) L、(63.64±3.67)%和(62.28±3.11) L,均显著高于ICNB组[(1.89±0.42) L、(56.61±3.19)%和(57.52±3.48) L],差异均有统计学意义(P<0.05)。联合阻滞组不良反应总发生率为18.00%,稍高于ICNB组的12.00%,但差异无统计学意义(P>0.05)。结论 超声引导下SAPB+ICNB可有效缓解胸腔镜下肺切除术后急性疼痛,明显减少术中及术后麻醉药用量,改善术后肺功能,且安全性良好。
Objective To investigate the effects of ultrasound-guided anterior serratus planus muscle(SAPB) combination with intercostal nerve block(ICNB) on acute pain,anesthetic dosage and pulmonary function in patients undergoing thoracoscopic lobectomy.Methods One hundred patients scheduled to undergo thoracoscopic lobectomy in Cangzhou people's Hospital from August 2020 to October 2021 were prospectively selected and divided into the combined block group(n=50) and the ICNB group(n=50) according to the random number table method.The patients in the combined block group received ultrasound-guided SAPB+ICNB,and ICNB group received ultrasound-guided ICNB.The perioperative related indexes[operation time,duration of anesthesia,total bleeding,post anesthesia care unit(PACU) time,time of getting out of bed,and hospital stay],visual analogue scale(VAS) scores of resting and coughing at different time points after operation,intraoperative and postoperative anesthetic dosage and pulmonary function indexes[forced expiratory volume in 1 second(FEV1),FEV1 to forced vital capacity percentage(FEV1/FVC),and maximal ventilatory volume(MVV)],and adverse reactions were compared.Results There were no statistically significant differences between the two groups in terms of operation time,duration of anesthesia,total bleeding,PACU time,and hospital stay(P>0.05);the time of getting out of bed in the combined block group was(25.61±3.04) h,which were shorter than that in the ICNB group[(31.64±3.48) h],the difference was statistically significant(P<0.05).The VAS scores at rest in the combined block group at 2,4,8,12 and 24 h after operation were(2.24±0.81),(2.68±0.79),(2.19±0.80),(1.68±0.52),and(1.09±0.33) points,respectively,the VAS scores at cough were(3.78±0.98),(3.88±1.06),(3.09±0.67),(1.96±0.43),and(1.59±0.38) points,respectively,which were significantly lower than those in the ICNB group at the same time point[at rest:(3.41±0.94),(3.89±0.94),(3.40±0.92),(2.44±0.58),(2.05±0.29) points,at cough:(4.67±0.91),(4.56±1.09),(4.15±0.62),(2.99±0.60),(2.53±0.44) points],the differences were statistically significant(P<0.05).The dosage of propofol and remifentanil during operation and the dosage of sufentanil at 24 and 48 hours,and the pressed number times of the analgesic pump within 48 h after surgery were(360.85±81.64) mg,(1.29±0.38) mg,(27.45±5.73) mg,(65.40±10.07) mg and(6.85±2.34) times,respectively,which were lower than those of the ICNB group[(398.47±90.12) mg,(1.56±0.32) mg,(34.83±5.28) mg,(69.65±9.42) and(8.91±2.51) times],the differences were statistically significant(P<0.05).The FEV1,FEV1/FVC and MVV in the combined block group were(2.19±0.36)L,(63.64±3.67)% and(62.28±3.11) L,which were higher than those in the ICNB group[(1.89±0.42)%,(56.61±3.19)%,(57.52±3.48) L],the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the combination block group was 18.00%,slightly higher than the 12.00% in the ICNB group,but the difference was not statistically significant(P>0.05).Conclusion Ultrasound-guided SAPB+ICNB can effectively relieve acute pain after thoracoscopic lobectomy,significantly reduce intraoperative and postoperative anesthetic dosage,improve postoperative pulmonary function with good safety.
作者
李晨
张慧玲
刘秀祥
王超
王晴晴
LI Chen;ZHANG Hui-ling;LIU Xiu-xiang(Department of Anesthesiology,Cangzhou People's Hospital,Cangzhou Hebei 061000,China)
出处
《临床和实验医学杂志》
2024年第3期329-333,共5页
Journal of Clinical and Experimental Medicine
基金
河北省2022年度医学科学研究课题计划(编号:20220325)。
关键词
胸腔镜肺切除术
前锯肌神经阻滞
肋间神经阻滞
急性疼痛
麻醉药用量
肺功能
Thoracoscopic lobectomy
Anterior serratus nerve block
Intercostal nerve block
Acute pain
Anesthetic dosage
Pulmonary function
