超声引导下前锯肌平面阻滞对保留自主呼吸的胸腔镜手术术后镇痛及应激反应的影响

doi:10.3969/j.issn.1005-6483.2020.08.027

摘要/Abstract

摘要： 目的探讨超声引导下前锯肌平面阻滞联合喉罩对保留自主呼吸的胸腔镜手术术后镇痛和应激反应的影响。
方法胸腔镜肺叶切除术病人60例，按随机数字表法将60例病人分为超声引导下前锯肌平面阻滞保留自主呼吸麻醉组（C组）和双腔管气管插管全麻组（N组），每组30例。分别于麻醉诱导前（T1）、手术开始后10分钟（T2）、手术开始后30分钟（T3）、手术结束后10分钟（T4）检测两组病人血糖、去甲肾上腺素和肾上腺素浓度;比较两组病人术中麻醉药物的用量、苏醒时间、术后24小时视觉模拟评分（VAS评分）和病人自控镇痛（PCA）镇痛泵舒芬太尼用量及PCA按压次数，病人首次排气时间、排便时间、住院时间。
结果两组病人T4时的血糖、去甲肾上腺素和肾上腺素的含量均升高，与T1、T2、T3时比较，差异有统计学意义（P＜0.05）； C组T4 时血糖、去甲肾上腺素和肾上腺素的含量低于相同时间段的N组，差异有统计学意义（P＜0.05）；与N组比较，C组病人术中麻醉药物用量、术后24小时 VAS评分和PCA舒芬太尼用量及PCA按压次数低于对照组，差异有统计学意义（P＜0.05），C组病人麻醉苏醒时间、首次排气时间、排便时间、住院时间均缩短，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在保留自主呼吸的胸腔镜手术中，能有效抑制围术期应激反应，为胸腔镜手术提供良好的术后镇痛，降低术后镇痛药物的使用，缩短麻醉苏醒时间和住院时间，促进术后康复。

关键词: 超声引导, 前锯肌平面阻滞, 自主呼吸, 应激反应, 术后镇痛

Abstract: Objective To investigate the effect of ultrasound-guided anterior serratus plane block combined with laryngeal mask on postoperative analgesia and stress response in thoracoscopic surgery with autonomous breathing.
Methods 60 patients with elective thoracoscopic lobectomy were selected.All patients were divided into two groups：Group C（SAPB group）and group N.Blood glucose，norepinephrine and adrenaline were measured before anesthesia induction（T1），10 minutes after operation（T2），30 minutes after operation（T3），and 10 minutes after operation（T4）.The consumption of general anesthesia drugs，visual analogue scores at rest，cumulative sufentanil consumption and the times of PCA compression times were recorded.The recovery time of anesthesia，the time of first exhaust，the time of defecation and the days of hospitalizationwere recorded.
Results The contents of blood glucose，noradrenaline and adrenaline in the two groups increased at T4 ，compared with T1、T2、T3，the difference was statistically significant（P<0.05）.Compared with group N，the contents of blood glucose，noradrenaline and adrenaline in group C were lower（P<0.05）.Compared with group N，intraoperative anesthetic drug dosage，VAS score 24 hours after operation，PCA dose of sufentanil and PCA compression frequency in group C were lower than those in the control group，and the differences were statistically significant（P<0.05）.The recovery time of anesthesia，the time of first exhaust，the time of defecation and the days of hospitalization in group C were all shortened（P<0.05）.
Conclusion The application of ultrasound-guided anterior serratus block in thoracoscopic surgery can effectively inhibit perioperative stress response，provide good postoperative analgesia for thoracoscopic surgery，reduce the use of postoperative analgesic drugs，shorten the time of anesthesia recovery and hospital stay，and promote the postoperative recovery of patients.

Key words: ultrasound guidance, anteriorserratus plane block, spontaneous respiration, stress response, postoperative analgesia

刘苹吴茜王思桦姚尚龙. 超声引导下前锯肌平面阻滞对保留自主呼吸的胸腔镜手术术后镇痛及应激反应的影响[J]. 临床外科杂志, 2020, 28(8): 784-786.

LIU Ping, WU Xi, WANG Sihua, et al.. The effect of ultrasound-guided anterior serratus block on postoperative analgesia and stress response in thoracoscopic surgery with autonomous breathing[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(8): 784-786.

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