文章摘要
超声引导下改良前锯肌平面阻滞对肝移植术患儿镇痛效果的影响
Effect of improved serratus anterior plane block under ultrasound guidance on analgesia in children undergoing liver transplantation
  
DOI：10.12089/jca.2021.10.002
中文关键词: 前锯肌平面阻滞  超声引导  患儿  肝移植  罗哌卡因
英文关键词: Serratus anterior plane block  Ultrasound guidance  Child  Liver transplantation  Ropivacaine
基金项目:广西自然科学基金(2018GXNSFAA281101);广西医疗卫生适宜技术开发与推广应用项目(S2019109);广西壮族自治区卫生健康委员会青年基金(Z20200160)
作者单位E-mail
庞冬琼 535000,南宁市,广西医科大学第一附属医院麻醉科  
周斌先 535000,南宁市,广西医科大学第一附属医院麻醉科  
朱馥如 535000,南宁市,广西医科大学第一附属医院麻醉科  
赖坚 535000,南宁市,广西医科大学第一附属医院麻醉科  
梁胜凤 535000,南宁市,广西医科大学第一附属医院麻醉科 709207927@qq.com 
蓝雨雁 535000,南宁市,广西医科大学第一附属医院麻醉科  
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中文摘要:
      
目的 观察经T6、T8水平入路的改良前锯肌平面阻滞(SAPB)对肝移植术患儿镇痛效果的影响。
方法 选择2019年1月至2020年12月择期行肝移植术患儿30例,男15例,女15例,年龄0～3岁,ASA Ⅲ或Ⅳ级。采用随机数字表法分为两组:全身麻醉联合改良SAPB组(S组)和全身麻醉组(C组),每组15例。气管插管后S组于双侧T6、T8水平行超声引导下改良SAPB,注入0.25％罗哌卡因1 ml/kg+地塞米松0.2 mg/kg,各注射点等量均分。两组麻醉诱导和麻醉维持方法一致。术后采用持续静脉泵注咪达唑仑2 μg·kg-1·min-1+瑞芬太尼3 μg·kg-1·h-1镇痛,并根据Comfort评分调整瑞芬太尼泵速。记录术中芬太尼及瑞芬太尼用量、术后瑞芬太尼用量及瑞芬太尼持续使用时间。于术后1、2、3、4、5、6 d检测总胆红素、白蛋白、AST、ALT浓度。记录ICU治疗时间、气管导管拔管时间以及术后肺部感染、肺不张的发生情况。
结果 与C组比较,S组术中、术后瑞芬太尼用量明显减少(P<0.05),术后瑞芬太尼持续使用时间明显缩短(P<0.05)。两组术中芬太尼用量差异无统计学意义。与术后1 d比较,S组术后2 d AST浓度和术后4 d总胆红素、ALT浓度明显降低(P<0.05)；C组术后2 d AST浓度和术后3 d ALT浓度明显降低(P<0.05)。与C组比较,S组ICU治疗时间明显缩短(P<0.05)。两组气管导管拔管时间以及术后肺部感染、肺不张发生率差异无统计学意义。
结论 全身麻醉联合超声引导下改良前锯肌平面阻滞可以减少肝移植术患儿术中、术后镇痛药物用量，可为肝移植术患儿提供良好的围术期镇痛。
英文摘要:
      
Objective To observe the analgesic effect of modified serratus anterior plane block (SAPB) via T6 and T8 approaches in children undergoing liver transplantation.
Methods Thirty children undergoing elective liver transplantation from January 2019 to December 2020, 15 males and 15 females, aged 0-3 years, ASA physical status Ⅲ or Ⅳ, were divided into two groups by random number table (n = 15): general anesthesia combined with modified SAPB group (group S) and general anesthesia group (group C). After tracheal intubation, the children in group S underwent ultrasound-guided bilateral T6 and T8 rib serratus anterior plane block. The local anesthetic dose was 0.25％ ropivacaine 1 ml/kg + dexamethasone 0.2 mg/kg, each injection point got equal amounts of local anesthetics. The methods of induction and maintenance of anesthesia were the same in the two groups. Continuous intravenous pump injection of midazolam 2 μg·kg-1·min-1 + remifentanil 3 μg·kg-1·h-1 was used for analgesia after operation, and the pumping speed of remifentanil was adjusted through the results of the Comfort assessment scale. The dosage of intraoperative fentanyl, postoperative remifentanil dosage and the postoperative remifentanil continuous pumping time were recorded. The concentration of albumin, total bilirubin, ALT and AST on the first to sixth day after operation were recorded. ICU treatment time, extubation time of tracheal tube, postoperative pulmonary infection, and atelectasis were recorded.
Results Compared with group C, the amount of remifentanil in group S was significantly reduced during and after operation (P < 0.05), and the continuously pumping time of remifentanil after operation was significantly shortened (P < 0.05). There was no significant difference in intraoperative fentanyl dosage between the two groups. Compared with 1 day after surgery, AST concentration 2 days after surgery and ALT and bilirubin concentration 4 days after surgery were significantly decreased in group S (P < 0.05), while AST concentration 2 days after surgery and ALT concentration 3 days after surgery were significantly decreased in group C (P < 0.05). The ICU treatment time in group S was shorter than that in group C (P < 0.05). However, there was no significant difference in the incidence of postoperative lung infection and atelectasis and the extubation time of the tracheal tube between the two groups.
Conclusion Ultrasound-guided modified SAPB combined with general anesthesia can reduce the amount of intraoperative and postoperative analgesic drug remifentanil in children undergoing liver transplantation, which can provide good perioperative analgesia for children undergoing liver transplantation.
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