文章摘要
超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响
Effect of ultrasound-guided single erector spinae plane block on postoperative self-controlled intravenous analgesia in patients undergoing video-assisted thoracoscopic lobectomy
  
DOI:
中文关键词: 超声引导  竖脊肌平面阻滞  肺叶切除  电视辅助胸腔镜手术  患者静脉自控镇痛
英文关键词: ultrasound-guided  Erector spinae plane block  Lobectomy  Video-assisted thoracic surgery  Patient-controlled intravenous analgesia
基金项目:2016年贝朗麻醉科学研究基金(BBDF-2016-006);2013北京市卫生系统高层次卫生技术人才项目资助(2013-3-018)
作者单位E-mail
马丹旭 100020,首都医科大学附属北京朝阳医院麻醉科  
任惠龙 北京中医药大学东直门医院麻醉科  
芮燕 100020,首都医科大学附属北京朝阳医院麻醉科  
马紫元 内蒙古赤峰松山医院麻醉科  
吴安石 100020,首都医科大学附属北京朝阳医院麻醉科  
王云 100020,首都医科大学附属北京朝阳医院麻醉科 wangyun129@ccmu.edu.cn 
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中文摘要:
      
目的:探讨超声引导下单次竖脊肌平面(erector spinae plane, ESP)阻滞联合患者自控静脉镇痛(PCIA)在胸腔镜下肺叶切除患者术后的镇痛效果。
方法:择期行胸腔镜下肺叶切除术患者40例, 男20例, 女20例, ASA Ⅰ或Ⅱ级。随机分为单次ESP阻滞联合PCIA组(EP组)和单纯PCIA组(P组)。EP组麻醉诱导前行ESP阻滞, 20 min后测定阻滞范围, 术毕两组均采用PCIA。记录术后1、6、18、24、48 h静息和咳嗽时VAS评分, 镇痛泵按压次数,输注总量,氟比洛芬酯给药次数, 以及术后不良反应发生情况。
结果:ESP阻滞20 min后可阻滞T2~T8或T3~T7脊神经支配区域, 术后1~48 h EP组静息和咳嗽时VAS评分明显低于P组(P<0.05), 镇痛泵按压次数、输注总量和氟比洛芬酯给药次数明显少于P组(P<0.05)。两组术后恶心、呕吐发生率差异无统计学意义。
结论:超声引导下单次竖脊肌平面阻滞联合PCIA的胸科手术辅助镇痛方式较单纯PCIA方式更为安全有效。
英文摘要:
      
Objective: To observe the effect of ultrasound-guided single erector spinae plane (ESP) block combined with patient-controlled intravenous analgesia (PCIA) on postoperative analgesia in patients undergoing lobectomy performed via video-assisted thoracoscope.
Methods: Forty patients (20 males and 20 females, ASA physical status Ⅰ or Ⅱ), scheduled for elective video-assisted thoracoscopic lobectomy, were randomly assigned into two groups, ESP block combined with PCIA group (group EP) and PCIA only group (group P). ESP block was given to patients in group EP before operation, and its effect was evaluated by testing the area of block. VAS scores were recorded at 1, 6, 18, 24 and 48 h after operation. The frequency for compress PCIA, the volume of analgesic drugs, the consumption of flurbiprofen axetil and the side-effects were recorded as well.
Results: ESP block was accomplished in group EP with sensory loss from T2-T8 or T3-T7 over the entire posterolateral aspect of the hemithorax. And there were no puncture-related complications. The VAS scores both at rest and coughing in group EP were lower than those in group P (P<0.05). The compress PCA numbers, the volume of analgesic drugs and the consumption of flurbiprofen axetil were significantly less in group EP than those in group P (P<0.05). Only nausea and vomiting were observed as postoperative side effects, and there were no significant differences between the two groups.
Conclusion: ultrasound-guided single erector spinae plane block combined with PCIA is a safer and more effective method for the analgesia of thoracic operation than PCIA only.
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