文章摘要
超声引导下竖脊肌平面阻滞对胸腔镜肺叶切除术患者术后肺功能的影响
Effect of ultrasound-guided erector spinae plane block on pulmonary function after thoracoscopic lobectomy
  
DOI：10.12089/jca.2020.01.004
中文关键词: 竖脊肌平面阻滞  肺功能  胸腔镜手术  超声引导
英文关键词: Erector spinae plane block  Pulmonary function  Thoracoscopic surgery  Ultrasound-guided
基金项目:国家自然科学基金（81873954）；六大高峰人才项目（WSW_106）
作者单位E-mail
张媛 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
方兆晶 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
单涛 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
孟庆胜 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
史宏伟 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
葛亚力 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
施韬 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
魏海燕 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
苏中宏 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
鲍红光 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 hongguang_bao@163.com 
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中文摘要:
      
目的 观察超声引导下竖脊肌平面阻滞(erector spinae plane block, ESPB)对胸腔镜肺叶切除术患者术后肺功能的影响。
方法 选择择期全麻下行胸腔镜肺叶切除术患者130例,男65例,女65例,年龄40～75岁,BMI 18～25 kg/m2,ASA Ⅰ或Ⅱ级,随机分为ESPB组(E组)和对照组(C组),每组65例。E组于术毕即刻行手术侧超声引导下ESPB,在竖脊肌深面注入0.375％罗哌卡因25 ml。C组不行神经阻滞。两组术后均行PCIA。记录麻醉诱导前(T0)、术后拔除气管导管后(T1)、拔除胸腔引流管后(T2)的一秒种用力呼气容积(FEV1)、用力肺活量(FVC)和最高呼气流速变异率(PEFR),记录T1、T2时术后限制性通气障碍、阻塞性通气障碍、混合型通气障碍的发生情况和Prince-Henry疼痛评分。记录PCIA泵有效按压次数(D1)、实际按压次数(D2)和术后补救镇痛次数。记录术后恶心呕吐(PONV)、呼吸困难等发生情况;记录拔气管导管时间(拔管时间)、胸腔引流管留置时间、住院时间。
结果 T1时E组FVC、PEFR明显高于C组(P<0.05),术后限制性通气障碍、阻塞性通气障碍、混合型通气障碍发生率和Prince-Henry评分明显低于C组(P<0.05)。T2时E组FEV1、FVC、PEFR明显高于C组(P<0.05),Prince-Henry评分明显低于C组(P<0.05)。E组D2明显少于C 组(P<0.05),补救镇痛次数明显低于C 组(P<0.05)。E组PONV、呼吸困难等并发症发生率明显低于C组（P<0.05）,胸腔引流管留置时间、住院时间明显短于C组(P<0.05)。
结论 超声引导下ESPB明显改善胸腔镜肺叶切除术患者术后肺功能,降低并发症,可能与充分的术后镇痛作用有关。
英文摘要:
      
Objective To assess the pulmonary function in patients undergoing ultrasound-guided erector spinae plane block (ESPB) after thoracoscopic lobectomy.
Methods A total of 130 patients undergoing thoracoscopic lobectomy under general anesthesia, aged 40-75 years,with a BMI 18-25 kg/m2, falling into ASA physical status Ⅰ or Ⅱ were randomly divided into 2 groups (n = 65): erector spinae plane block group (group E) and control group (group C). At the end of surgery, group E received ultrasound-guided ESPB at surgery side, and injected into the deep surface of vertical spinal muscle with 0.375％ ropivacaine 25 ml. But no nerve block in group C. PCIA was performed in both groups. The pulmonary function tests including forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) were performed before anesthesia induction (T0), tracheal extubation (T1) and removing the chest tube (T2). The incidence of restrictive, obstructive, mixed ventilation dysfunction were recorded and Prince-Henry scores of postoperative pain were evaluated at T1 and T2. The effective compress number (D1) and attempts (D2) of PCIA were recorded. The rescue analgesic was recorded. Postoperative nausea and vomiting (PONV) and dyspnea were recorded. The duration of intubation, duration of chest tube, hospitalization and adverse effects after surgery were recorded.
Results In group E, FVC, PEFR of T1were significantly higher than those in group C (P<0.05). The incidence of restrictive, obstructive, mixed ventilation dysfunction and Prince-Henry scores of T1 decreased compared with group C (P<0.05). FEV1, FVC and PEFR of T2were significantly higher than that in group C (P<0.05). The Prince-Henry scores of T2decreased compared with group C (P<0.05). The D1 of PCIA decreased compared with group C (P<0.05). The rescue analgesic decreased compared with group C (P<0.05). The incidence of PONV and dyspnea obviously decreased compared with group C (P<0.05). The duration of chest tube and hospitalization decreased compared with group C (P<0.05).
Conclusion The ultrasound-guided erector spinae plane block is effective for reducing the incidence of complication and protecting of pulmonary function after thoracoscopic lobectomy because of adequate postoperative analgesia.
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