文章摘要
超声引导下竖脊肌平面阻滞联合腹横肌平面阻滞用于两切口食管癌根治术后镇痛的效果
Effects of ultrasound-guided erector spinae plane block combined with transversus abdominis plane block on postoperative pain and satisfaction in patients undergoing radical resection of esophageal carcinoma with two incisions
  
DOI：10.12089/jca.2019.07.001
中文关键词: 超声引导  竖脊肌平面阻滞  腹横肌平面阻滞  患者自控静脉镇痛  食管癌根治术  术后镇痛
英文关键词: Ultrasound guided  Erector spinae plane block  Transversus abdominis plane block  Patient controlled intravenous analgesia  Esophagectomy  Postoperative analgeisia
基金项目:中国癌症基金会北京希望马拉松专项基金资助(LC2017A09)
作者单位E-mail
王强 100021,北京市,国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院麻醉科  
张国华 100021,北京市,国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院麻醉科  
何志斌 100021,北京市,国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院麻醉科  
律方 100021,北京市,国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院胸外科  
郑晖 100021,北京市,国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院麻醉科 zhenghui_zlyy@163.com 
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中文摘要:
      
目的 探索超声引导下竖脊肌平面阻滞(erector spinae plane block, ESPB)联合腹横肌平面阻滞(transversus abdominis plane block, TAPB)用于右胸及上腹两切口食管癌根治术后镇痛的效果及其对患者满意度的影响。
方法 择期行两切口食管癌根治术的患者40例，男23例，女17例，年龄30～65岁，BMI 18～30 kg/m2，ASAⅠ或Ⅱ级。所有患者随机分为ESPB联合TAPB镇痛组 (ET组)和单纯患者自控静脉镇痛（PCIA）组 (IA组)。ET组全麻诱导前行超声引导下ESPB、超声引导下TAPB，分别于操作结束20 min后测定阻滞范围，IA组不予阻滞，两组术毕均采用PCIA。记录患者入手术室后(T0)、气管插管时(T1)、手术切皮时(T2)、手术30 min(T3)、60 min(T4)、90 min时(T5)、手术结束时(T6)的HR、MAP；术后1、6、12、24、48 h静息和咳嗽时VAS评分；镇痛泵按压次数；镇痛泵药液输注总量；术后不良反应发生情况和患者总体满意度。
结果 ESPB 20 min后可阻滞T3—T9脊神经支配区域，TAPB 20 min后可阻滞T9—L1脊神经支配区域。与T0时比较，T2时IA组HR明显增快、MAP明显升高（P<0.05），T0和T2时ET组HR和MAP差异无统计学意义。T2—T6时IA组HR明显快于ET组、MAP明显高于ET组（P<0.05）。ET组术后1、6、12、24、48 h静息和咳嗽时VAS评分明显低于IA组(P<0.05)，术后0~24 h和0~48 h镇痛泵按压次数和药液输注总量明显少于IA组(P<0.05)，术后恶心、呕吐发生率明显低于IA组(P<0.05)，患者满意度评分明显高于IA组(P<0.05)。
结论 超声引导下单次竖脊肌平面阻滞联合腹横肌平面阻滞用于经右胸及上腹两切口食管癌根治术可有效抑制术中血流动力学波动，其术后镇痛效果优于单纯患者自控静脉镇痛，患者总体满意度更高。
英文摘要:
      
Objective To observe the effects of ultrasound-guided single erector spinae plane block (ESPB) combined with ultrasound-guided transversus abdominis plane block (TAPB) on postoperative pain and satisfaction in patients undergoing radical resection of esophageal carcinoma with two incisions on right chest and upper abdomen.
Methods Forty patients, scheduled for radical resection of esophageal carcinoma with two incisions, 23 males and 17 females, BMI 18 - 30 kg/m2, ASA physical statusⅠorⅡ, were randomly assigned into two groups, ESPB combined with TAPB group (group ET) and PCIA only group (group IA). ESPB and TAPB were performed in group ET before anesthesia induction, and their effects were evaluated by testing the area of block. The HR and MAP at the time of entering the operating room (T0), time of endotracheal intubation (T1), time of surgical incision (T2), 30 min (T3), 60 min (T4) and 90 min after operation (T5), and time at end of operation (T6) were all recorded. Visual analogue scale (VAS) scores were recorded at 1, 6, 12, 24 and 48 h after operation. The frequency for press times of analgesic pump, the volume of analgesic drugs, the side effects and patients's overall satisfaction were recorded as well.
Results ESPB was accomplished in group ET with pain sense loss from T3 - T9. And TAPB was carried out in group ET with pain sense loss from T9 - L1. And there were no puncture-related complications. In group IA, the MAP and HR at T2 both elevated compared with those at T0 (P < 0.05). However, in group ET, there were no significant differences between T0 and T2 in the HR and MAP. And compared with group IA, the HR and MAP of group ET at T2 - T6 were all significantly decreased (P < 0.05). The VAS scores both at rest and coughing in group ET were lower than those in group IA (P < 0.05). The times of analgesic pump compression and the volume of analgesic drugs were significantly less in group ET than those in group IA (P < 0.05). The incidence rate of nausea and vomiting was significantly lower in group ET than that in group IA (P < 0.05). And the degree of satisfaction in group ET was significantly higher than that in group IA (P < 0.05).
Conclusion For radical resection of esophageal carcinoma with two incisions on right chest and upper abdomen, ESPB combined with TAPB can effectively inhibit the intraoperative hemodynamic fluctuation and provide more effective postoperative analgesia and higher gross satisfaction than patient with controlled intravenous analgesia only.
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