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| 前锯肌平面阻滞对胸腔镜手术患者术后急性疼痛和炎症反应的影响 |
| Effect of serratus anterior plane block on acute pain and inflammatory response in patients undergoing thoracoscopy |
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| DOI：10.12089/jca.2021.07.008 |
| 中文关键词: 超声 前锯肌平面阻滞 胸腔镜 急性疼痛 丙泊酚 |
| 英文关键词: Ultrasound Serratus anterior plane block Thoracoscopy Acute pain Propofol |
| 基金项目:温州市科技计划经费自筹项目（Y20180566） |
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| 中文摘要: |
目的 观察前锯肌平面阻滞（SAPB）对胸腔镜手术患者术后急性疼痛和炎症反应的影响。
方法 选择2018年2月至2020年2月拟行胸腔镜手术患者104例，男64例，女40例，年龄26～64岁，BMI 18～24 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法将其分为两组，每组52例。S组采用全麻联合术前30 min行SAPB。C组术中采用单纯全麻。记录术后2、4、12、24 h静息及咳嗽状态下VAS疼痛评分。记录术前、术毕、术后12、24 h的T淋巴细胞亚群水平（CD4+、CD3+、CD4+/CD8+）、白细胞介素-10（IL-10）、皮质醇（Cor）、肿瘤坏死因子-α（TNF-α）浓度。记录术中丙泊酚和瑞芬太尼用量、镇痛泵总有效按压次数（D1）、镇痛泵实际按压次数（D2）、D1/D2、氟比洛芬酯和舒芬太尼补救例数及不良反应发生情况。
结果 术后2、4、12 h S组咳嗽时及静息状态下VAS评分明显低于C组（P＜0.05）。术毕、术后12 h，S组的CD4+、CD3+、CD4+/CD8+水平明显高于C组（P＜0.05）。术毕、术后12 h S组血清IL-10、TNF-α、Cor浓度明显低于C组（P＜0.05）。S组术中丙泊酚和瑞芬太尼用量、D1、D2、氟比洛芬酯和舒芬太尼补救例数明显少于C组，D1/D2明显高于C组（P＜0.05）。两组恶心、呕吐、胸膜刺破等不良反应发生率差异无统计学意义。
结论 全麻联合SAPB可为胸腔镜手术患者提供良好的术后镇痛，且能减轻炎症反应。 |
| 英文摘要: |
Objective To explore the effect of serratus anterior plane block (SAPB) on postoperative acute pain and inflammatory reaction in patients undergoing thoracoscopic surgery.
Methods A total of 104 patients undergoing thoracoscopic surgery from February 2018 to February 2020, 64 males and 40 females, aged 26-64 years, BMI 18-24 kg/m2, ASA physical status Ⅰ or Ⅱ, were divided into two groups by random number table method, 52 patients in each group. Group C received general anesthesia only, and group S received SAPB combined with general anesthesia. The visual analeg scale (VAS) scores at 2, 4, 12, 24 hours after operation at rest and cough state, the levels of T-lymphocyte subsets (CD4+, CD3+, CD4+/CD8+) and inflammatory stress indexes including interleukin-10 (IL-10), cortisol (Cor), tumor necrosis factor-α (TNF-α) before operation, immediately after operation, 12 hours and 24 hours after operation, the dosage of propofol, remifentanil, total effective pressing times (D1), actual pressing times (D2), D1/D2 value, rescue cases of flurbiprofen axetil, rescue cases of sufentanil and adverse reactions were recorded.
Results At 2, 4, and 12 hours after surgery, the VAS scores in group S was lower than that in group C (P < 0.05). The levels of CD4+, CD3+, CD4+/CD8+ in group S were higher than those in group C immediately after operation and 12 hours after operation (P < 0.05). The serum levels of IL-10, TNF-α and Cor in group S were lower than those in group C immediately after operation and 12 hours after operation (P < 0.05). The dosage of propofol, remifentanil, D1, D2, rescue cases of flurbiprofen axetil and rescue cases of sufentanil in group S were less than those in group C (P < 0.05). D1/D2 value in group S was higher than that in group C (P < 0.05). There was no significant difference in the incidence of adverse reactions such as nausea, vomiting, and pleural puncture between the two groups.
Conclusion SAPB is safe and effective in patients undergoing thoracoscopic surgery. |
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