文章摘要
超声引导下前锯肌平面阻滞对老年患者胸腔镜肺叶切除术后心肌酶和肌钙蛋白T的影响
Effect of ultrasound-guided serratus anterior plane block on myocardial enzymes and troponin T in elderly patients undergoing thoracoscopic pulmonary lobectomy
  
DOI：10.12089/jca.2020.11.007
中文关键词: 前锯肌平面阻滞  胸腔镜  肺叶切除术  心肌酶  肌钙蛋白T
英文关键词: Serratus anterior plane block  Thoracoscopic  Pulmonary lobectory  Myocardial enzymes  Troponin T
基金项目:
作者单位E-mail
夏梦 210029,南京医科大学附属南京脑科医院（胸科院区）麻醉科  
孙杨 210029,南京医科大学附属南京脑科医院（胸科院区）麻醉科  
姚昊 南京医科大学第二附属医院麻醉科 yaohao@njmu.edu.cn 
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中文摘要:
      
目的 观察超声引导下前锯肌平面阻滞（SAPB）对老年患者胸腔镜肺叶切除术后心肌酶和肌钙蛋白T（cTnT）的影响。
方法 拟行胸腔镜肺叶切除术的老年患者60例，男24例，女36例，年龄65~78岁，BMI 19~26 kg/m2，ASA Ⅱ或Ⅲ级，随机分为两组：SAPB组（A组）和对照组（G组），每组30例。A组全身麻醉诱导后行超声引导下SAPB，注入0.375%罗哌卡因20 ml。两组术中均行丙泊酚、瑞芬太尼静脉麻醉。记录术中阿片类药物用量，麻醉诱导前、术毕、术后6、24、48 h的MAP、HR、CVP，同时抽取外周静脉血检测心肌酶和cTnT，包括磷酸肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH），并评估术后6、24、48 h静息和咳嗽时VAS评分，记录术后48 h内PCIA给药总量、有效按压次数和补救镇痛次数。
结果 术后24 h内A组HR明显慢于、MAP明显低于G组（P＜0.05）。术后24 h内A组静息与咳嗽时VAS评分明显低于G组，术后48 h内PCIA给药总量、有效按压次数和补救镇痛次数均明显低于G组（P＜0.05）。与麻醉诱导前比较，术后6、24、48 h两组cTnT，术毕、术后6、24、48 h两组CK，术后6、24 h两组CK-MB和术毕、术后6、24 h LDH均明显升高（P＜0.05）。术后6、24、48 h，A组cTnT明显低于G组（P＜0.05）。
结论 超声引导下SAPB联合全麻有助于降低胸腔镜肺叶切除术老年患者术后肌钙蛋白T水平，起到一定的心肌保护作用。
英文摘要:
      
Ojective To observe the effect of ultrasound-guided serratus anterior plane block (SAPB) on myocardial enzymes and troponin T (cTnT) in elderly patients undergoing thoracoscopic pulmonary lobectomy.
Methods Sixty elderly patients, 24 males and 36 females, aged 65-78 years, BMI 19-26 kg/m2, falling into ASA physical status Ⅱ or Ⅲ, scheduled for elective thoracoscopic surgery, were randomly divided into two groups (n = 30): anterior serratus plane block group (group A) and general anesthesia group (group G). Patients in group A were performed ultrasound guided SAPB after general anesthesia and injected 20 ml of 0.375% ropivacaine. Both groups were conducted venous anesthesia by propofol and remifentanil. The intraoperative opioid dosage of the two groups was recorded. MAP, HR and CVP were recorded before anesthesia induction, at the end of the operation and 6, 24, and 48 h after operation. The concentration of myocardial enzymes (CK, CK-MB, LDH) and cTnT were measured in peripheral venous blood at the same time. Resting and cough VAS score were evaluated 6, 24, 48 h after operation. The total analgesic consumption during PCIA, the number of successfully delivered dose and the requirement for rescue analgesia within 48 h after surgery were recorded.
Results Compared with group G, HR and MAP were significantly lower in group A within 24 h after operation (P < 0.05). Compared with group G, the total analgesic consumption during PCIA and the number of successfully delivered doses were significantly decreased (P < 0.05), resting and cough VAS scores within 24 h in group A were significantly lower than those in group G (P < 0.05). Compared with before induction of anesthesia, cTnT 6, 24, 48 h after operation, CK 48 h after operation, CK-MB 6, 24 h after operation, and LDH 24 h after operation were significantly increased in both groups (P < 0.05). Compared with group G, concentration of cTnT 6, 24, 48 h were lower in group A (P < 0.05).
Conclusion Ultrasound-guided SAPB combined with general anesthesia can reduce the level of troponin T in elderly patients after thoracoscopic lobectomy with certain myocardium protection function.
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