文章摘要
超声引导下前锯肌平面阻滞联合患者自控静脉镇痛对开腹肝部分切除术后早期康复的影响
Effects of ultrasound guided serratus anterior plane block
  
DOI：10.12089/jca.2021.01.002
中文关键词: 前锯肌平面阻滞  自控静脉镇痛  肝部分切除术  超声引导  早期康复质量
英文关键词: Serratus anterior plane block  Patient-controlled intravenous analgesia  Partial hepatectomy  ultrasound-guided  Quality of early recovery
基金项目:安徽省学术和技术带头人科研活动经费（2017D147）
作者单位E-mail
唐宇翔 230032,合肥市,安徽医科大学附属省立医院麻醉科  
疏树华 230032,合肥市,安徽医科大学附属省立医院麻醉科 sshhf@189.cn 
柴小青 230032,合肥市,安徽医科大学附属省立医院麻醉科  
章敏 230032,合肥市,安徽医科大学附属省立医院麻醉科  
许辉 230032,合肥市,安徽医科大学附属省立医院麻醉科  
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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）联合患者自控静脉镇痛（PCIA）在开腹肝部分切除手术后镇痛中的有效性和安全性，以及对患者早期康复的影响。
方法 选择择期行开腹肝部分切除手术患者60例，男32例，女28例，年龄26~79岁，BMI 18~30 kg/m2 ，ASA Ⅰ—Ⅲ级。随机分为两组：SAPB联合PCIA组（S组，n=30）和单纯PCIA组（D组，n=30）。S组在手术结束后于右侧腋中线7～8、8～9肋间行SAPB，两点分别注入0.375%罗哌卡因10 ml；D组不作处理。两组术后均使用PCIA，配方：舒芬太尼2 μg/kg+昂丹司琼16 mg+生理盐水稀释至100 ml，无背景剂量，单次剂量2 ml，锁定时间15 min。记录术后2、6、12、24、48 h静息、咳嗽时VAS疼痛评分和Ramsay镇静评分，若静息时VAS疼痛评分>4分，则静脉输注氟比洛芬酯50 mg；记录术后0～2、2～6、6～12、12～24、0～24 h镇痛泵按压次数及舒芬太尼用量；记录术后首次排气时间、术后首次下床活动时间和术后住院时间；术后恶心、呕吐、头晕、瘙痒、呼吸抑制、心动过缓、低血压等不良反应的发生情况。
结果 与D组比较，S组术后6、12、24 h静息、咳嗽时VAS疼痛评分明显降低，术后2～6、6～12、12～24、0～24 h镇痛泵按压次数及舒芬太尼用量明显减少，术后首次排气时间、术后首次下床活动时间、术后住院时间明显缩短（P<0.05）。S组术后有4例（13.3%），D组术后有9例（30.0%）输注氟比洛芬酯，两组差异无统计学意义。两组术后Ramsay镇静评分和恶心、呕吐、头晕发生率差异无统计学意义。
结论 超声引导下SAPB联合PCIA用于开腹肝部分切除手术镇痛效果良好，有助于患者的早期康复。
英文摘要:
      
Objective To observe the analgesic effect and safety of ultrasound-guided serratus anterior plane block (SAPB) combined with patient-controlled intravenous analgesia (PCIA) on open partial hepatectomy and explore its impact on patients' early recovery.
Methods Sixty patients undergoing elected operation of open partial hepatectomy, 32 males and 28 females, aged 26-79 years, BMI 18-30 kg/m2 , ASA physical status Ⅰ-Ⅲ, were randomly assigned into two groups: SAPB combined with PCIA group (group S) and PCIA only group (group D), each group enrolled 30 patients. In group S, SAPB was performed at the right midaxillary line 7-8, 8-9 between the intercostal space after the operation, and 0.375% ropivacaine 10 ml was injected at two points. Group D was left untreated. Both groups used PCIA after surgery. PCIA formula: sufentanil 2 μg/kg + ondansetron 16 mg + saline diluted to 100 ml; PCIA parameters: no background dose, single dose 2 ml, lock time 15 minutes. The VAS score at rest and during the cough and Ramsay sedation score 2, 6, 12, 24, and 48 hours after surgery were recorded. If VAS score > 4 at rest, flurbiprofen 50 mg was infused intravenous. The number of analgesic pump presses and the amount of sufentanil within 0-2, 2-6, 6-12, 12-24, and 0-24 hours after surgery, the first postoperative exhaust time, the first postoperative time to get out of bed, the length of postoperative hospital stay, and postoperative adverse reactions including nausea and vomiting, pruritus, respiratory depression, bradycardia and hypotension were recorded.
Results Compared with group D, the VAS score at rest and during the cough of group S at 6, 12, and 24 hours after surgery were significantly lower, the number of analgesic pump compressions and the amount of sufentanil at 2-6, 6-12, 12-24, and 0-24 hours after surgery were significantly less, and the first postoperative exhaust time, the first postoperative time to get out of bed, and the length of postoperative hospital stay were significantly shorter (P < 0.05). Postoperative Ramsay sedation scores and adverse reactions including nausea and vomiting, pruritus, respiratory depression, bradycardia, and hypotension had no statistically significant differences between two groups. There were 4 (13.3%) patients in group S and 9 (30.0%) patients in group D getting the infusion of flurbiprofen axetil after operation, the difference was not statistically significant between two groups.
Conclusion ultrasound-guided SAPB combined with PCIA has good analgesic effect on open partial hepatectomy and is helpful for patients' early recovery.
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