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| 前锯肌平面阻滞对非小细胞肺癌胸腔镜根治术患者术后镇痛效果的影响 |
| Analgesic effect of serratus anterior plane block on patients with non-small cell lung cancer after video-assisted thoracoscopic surgery |
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| DOI：10.12089/jca.2019.05.005 |
| 中文关键词: 前锯肌平面阻滞 肺癌根治术 功能锻炼 术后镇痛 |
| 英文关键词: Serratus plane block Lung cancer radical resection Functional exercise Postoperative analgesia |
| 基金项目:南通大学附属医院护理科研专项计划项目（Tfh1708） |
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| 中文摘要: |
目的 探讨前锯肌平面阻滞对胸腔镜手术患者术后镇痛效果的影响。
方法 选取2017年7—12月住院治疗的早期非小细胞肺癌患者40例，性别不限，年龄48～67岁，BMI 21.3~26.7 kg/m2,ASA Ⅰ或Ⅱ级,按照随机分组的原则，将患者分为前锯肌平面阻滞组（SP组，n=20）和对照组（C组，n=20）。记录术后在PACU内舒芬太尼追加剂量及总用量、48 h内疼痛VAS评分、48 h内镇痛泵有效按压次数及总按压次数；记录功能锻炼依从性及慢性疼痛的发生率;记录患者局麻药中毒、皮下血肿、感染、皮肤瘙痒、头晕、恶心呕吐、尿潴留、便秘等不良反应的发生情况。
结果 与C组比较，SP组术后舒芬太尼追加剂量及总舒芬太尼用量明显减少（P＜0.05）；术后2、4、8、24、48 h疼痛VAS评分明显降低（P＜0.05）；48 h内PCIA有效按压次数及总按压次数明显减少(P＜0.05)；功能锻炼依从性明显较好（P＜0.05）。两组慢性疼痛发生率差异无统计学意义。两组镇痛不良反应差异无统计学意义。
结论 对于非小细胞肺癌胸腔镜手术患者，前锯肌平面阻滞联合静脉自控镇痛的多模式镇痛可有效控制术后疼痛，减少镇痛药的用量、镇痛泵按压次数和慢性疼痛的发生率，提高患者呼吸功能锻炼的依从性。 |
| 英文摘要: |
Ojective To investigate the analgesic effect of anterior serratus plane block for early stage non-small cell lung cancer (NSCLC) patients who undergoing thoracoscopic lobectomy.
Methods From July to December in 2017, forty early stage NSCLC patients in our unit were enrolled, no gender limitation, aged 48 - 67 years, BMI 21.3 - 26.7 kg/cm2, falling into ASA physical status Ⅰ or Ⅱ, according to the principle of randomized control, 40 patients were then divided into anterior serratus plane block group (group SP, n=20) and control group (group C, n=20). Postoperative parameters such as sufentanil ensufix usage in post anesthesia care unit (PACU), pain score at 2, 4, 8, 24 and 48h postoperatively, number of effective compressions and total number of compressions for patients-controlled intravenous analgesia (PCIA) pump, compliance of functional training and incidence of chronic pain were compared between the two groups. During PCIA, the occurrence of complications were recorded.
Results Compared with group C, the supplemental dosage and total consumption of sufentanil in group SP were decreased (P<0.05). Meanwhile, the pain scores within 48 h in group SP has better advantage than those in group C (P<0.05), and the total number of compressions for PCIA were more limited in group SP. The compliance of functional exercise in group SP was also better. However, there was not different in the chronic pain scores and the proportion of adverse drug reaction between two groups.
Conclusion For thoracoscopic lobectomy,anterior serratus plane block combining the patients-controlled intravenous analgesia (PCIA) can effectively control the postoperative acute pain, reduce the dosage of analgesic, PCIA pump press times and the incidence of postoperative chronic pain, thus promoting the compliance of functional exercise. |
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