超声引导下椎旁神经阻滞和改良前锯肌阻滞对单孔胸腔镜手术围手术期镇痛效果的比较-东南大学学报医学版

超声引导下椎旁神经阻滞和改良前锯肌阻滞对单孔胸腔镜手术围手术期镇痛效果的比较

作者：江山孙杨

单位：南京市胸科医院/南京医科大学附属脑科医院(胸科院区) 麻醉科, 江苏南京 210029

分类号：R616.5;R614.4

出版年·卷·期（页码）：2021·40·第六期（778-784）

摘要：

目的: 比较超声引导下椎旁神经阻滞和改良前锯肌阻滞对单孔胸腔镜手术围手术期镇痛的效果。方法: 选取行择期单孔胸腔镜胸科手术患者, 随机分为椎旁神经阻滞组(Z组)和改良前锯肌组(L组)。两组患者均于麻醉诱导后行相应神经阻滞操作。记录两组患者术前, 术后24、48、72 h静息和运动状态的疼痛视觉模拟量表评分(VAS评分); 统计两组患者术中血管活性药物应用次数、舒芬太尼和瑞芬太尼的用量、术后补救镇痛次数、自控按压次数, 记录两组患者神经阻滞操作并发症发生情况。结果: 最终纳入Z组患者61例, L组患者62例, 两组患者各时点静息和运动状态的VAS评分差异无统计学意义(P > 0.05);术中血管活性药物应用次数Z组多于L组(P < 0.05);肺段切除术中L组瑞芬太尼用量大于Z组(P < 0.05);两组术后补救镇痛和神经阻滞并发症差异无统计学意义(P > 0.05)。结论: 单孔胸腔镜手术中改良前锯肌阻滞和椎旁神经阻滞镇痛效果相当; 与椎旁神经阻滞比, 改良前锯肌阻滞对术中循环的影响更小。

Objective: To compare the effect of modified serratus anterior nerve block and ultrasound-guided paravertebral nerve block for pain management after uni-portal thoracoscopic surgery.Methods: Patients were divided into paravertebral nerve block group (Group Z) and modified serratus anterior nerve block group(Group L) randomly, which underwent uni-portal thoracoscopic surgery electively. After anesthesia induction, nerve block operation was performed in both groups. Visual analogue scale (VAS) scores with rest and motion state were evaluated respectively at pre-operation, postoperative 24 h, postoperative 48 h and postoperative 72 h. Application numbers of intraoperative vasoactive drugs, dosage of intraoperative sufentanil and remifentanil, numbers of rescued analgesia and self-control press after surgery were recorded. Complications of nerve block were also observed in both groups.Results: VAS scores with rest and motion state were not different between Group Z(n=61) and Group L(n=62)(P > 0.05). Application numbers of intraoperative vasoactive drugs in Group Z were more than those of Group L(P < 0.05).Dosage of remifentanil in Group L with pulmonary segmentectomy was higher than that of Group Z(P < 0.05). There was no difference in numbers of rescued analgesia and complications of nerve block(P > 0.05).Conclusion: Modified serratus anterior nerve block and paravertebral nerve block can offer the similar perioperative analgesia in uni-portal thoracoscopic lobectomy. Modified serratus anterior nerve block has less effect on intraoperative circulation compared with paravertebral nerve block.

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