文章摘要
超声引导下低位前锯肌平面阻滞对上腹部手术患者术后镇痛及炎症反应的影响
Effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia after upper-abdominal surgery
  
DOI：10.12089/jca.2021.02.008
中文关键词: 低位前锯肌平面阻滞  超声  术后镇痛  上腹部
英文关键词: Subserratus anterior plane block  Ultrasonography  Postoperative analgesia  Upper-
基金项目:广东省中医药管理局科研项目（20181272）；中山市科技计划项目（2017B1066）
作者单位E-mail
朱小兵 528400,广州中医药大学附属中山医院,中山市中医院麻醉科  
张喜洋 南方医科大学南方医院麻醉科 zhangxiy@163.com 
吴论 528400,广州中医药大学附属中山医院,中山市中医院麻醉科  
彭学强 528400,广州中医药大学附属中山医院,中山市中医院麻醉科  
陈浩 528400,广州中医药大学附属中山医院,中山市中医院麻醉科  
何佩玲 528400,广州中医药大学附属中山医院,中山市中医院麻醉科  
摘要点击次数: 2082
全文下载次数: 1448
中文摘要:
      
目的 评价超声引导下低位前锯肌平面阻滞（SAPB）对上腹部手术患者术后镇痛及炎症反应的影响。
方法 择期上腹部手术患者120例，男69例，女51例，年龄18～65岁，ASA Ⅰ或Ⅱ级。随机分为三组：对照组（C组，n=39），不行神经阻滞；常规SAPB组（SAPB组，n=40），全麻诱导前超声引导下双侧腋中线第5肋水平前锯肌平面阻滞；低位SAPB组（SSPB组，n=40），全麻诱导前超声引导下双侧腋中线第8肋水平前锯肌平面阻滞。三组均采用全麻气管插管，术中静-吸复合麻醉维持，术毕行舒芬太尼PCIA。术后48 h内VAS疼痛评分≥4分时，静脉注射舒芬太尼0.1 μg/kg补救镇痛，记录术后48 h内舒芬太尼用量、镇痛泵按压次数及补救镇痛例数。于麻醉前、术后4、24、48 h采集静脉血，采用ELLSA法检测血清白细胞介素（IL）-1、IL-6、IL-10浓度。记录术后48 h内恶心、呕吐等不良反应发生情况。
结果 SSPB组术后48 h内舒芬太尼用量、镇痛泵按压次数明显少于C组，补救镇痛率和不良反应发生率明显低于C组（P<0.05）。术后4、24、48 h SSPB组血清IL-1及IL-6浓度明显低于C组，IL-10浓度明显高于C组（P<0.05）。C组、SAPB组术后48 h内舒芬太尼用量、镇痛泵按压次数、补救镇痛率、术后不同时点血清IL-1、IL-6、IL-10浓度差异无统计学意义。
结论 超声引导下低位前锯肌平面阻滞用于上腹部手术患者术后镇痛效果优于常规前锯肌平面阻滞，减轻炎症反应且不良反应少。
英文摘要:
      
Objective To evaluate the effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia after upper-abdominal surgery.
Methods A total of 120 patients scheduled for elective upper-abdominal surgery under general anesthesia, 69 males and 51 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, were divided into 3 groups using a random number table method: control group (group C, n = 39), serratus anterior plane block group (group SAPB, n = 40), and subserratus anterior plane block group (group SSPB, n = 40). In group SSPB, ultrasound-guided subserratus anterior plane block were performed on both sides. Patient-controlled intravenous analgesia (PCIA) was performed at the end of the surgery. PCIA pump was pressed when VAS pain scores ≥ 4 after surgery and sufentanil 0.1 μg/kg was intravenously injected when the efficacy was inadequate. The requirement for PCIA pressing, and the amount of sufentanil consumed were recorded. Venous blood were collected immediately 4, 24, and 48 hours after surgery for determination of serum interleukin-1 (IL-1), IL-6, and IL-10 concentrations by enzyme-linked immunosorbent assay. The requirement for rescue analgesia and development of nausea and retching/vomiting were recorded within 48 hours after surgery.
Results The amount of sufentanil, the number of remedial analgesia and the number of analgesic pump compressions during the operation and 48 hours after the operation in group SSPB were significantly less than those in group C (P < 0.05), and the incidence of adverse reactions in group SSPB was significantly lower than that in group C (P < 0.05). The serum levels of IL-1 and IL-6 in group SSPB were significantly lower than those in group C 4, 24, and 48 hours after the operation, and the IL-10 concentration in group SSPB was significantly higher than that in group C (P < 0.05). There were no statistical differences in the amount of sufentanil, the number of times of analgesic pump compression, salvage analgesia rate, and serum IL-1, IL-6, and IL-10 concentrations at different time points after surgery in groups C and SAPB during operation and 48 hours after operation.
Conclusion ultrasound-guided SSPB provides good efficacy for postoperative analgesia in the patients undergoing upper-abdominal surgeries, and can significantly reduce the release of inflammatory factors.
查看全文   查看/发表评论  下载PDF阅读器
关闭