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| 超声引导下持续肋间神经阻滞对双孔胸腔镜手术患者术后早期恢复的影响 |
| Effects of ultrasound-guided continuous intercostal nerve block on postoperative early recovery after two-port video-assisted thoracic surgery |
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| DOI：10.12089/jca.2022.06.008 |
| 中文关键词: 超声引导 肋间神经 持续阻滞 胸腔镜手术 术后镇痛 |
| 英文关键词: Ultrasound-guided Intercostal nerve Continuous block Video-assisted thoracic surgery Postoperative analgesia |
| 基金项目:苏州市金鸡湖卫生人才项目（苏园社党字〔2021〕11号） |
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| 中文摘要: |
目的 探讨超声引导下持续肋间神经阻滞对双孔胸腔镜手术患者术后早期恢复的影响。
方法 选择择期在全麻下行双孔胸腔镜肺癌根治术患者60例，男33例，女27例，年龄18～64岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：持续肋间神经阻滞组（CB组）和单次肋间神经阻滞联合口服镇痛组（SB组），每组30例。CB组由麻醉科医师于关胸后在胸腔引流管切口处实施超声引导下肋间神经置管，术后接受PCA持续阻滞（0.2%罗哌卡因、舒芬太尼0.5 μg/ml加生理盐水稀释至200 ml，背景剂量4 ml/h，PCA剂量4 ml，锁定时间15 min）；SB组于关胸前由外科医师在胸腔镜直视下在切口及其相邻上下两个肋间实施单次肋间神经阻滞（0.5%罗哌卡因，每肋间3 ml），术后口服氨酚曲马多片。记录入PACU后30 min、术后6、12、24、48 h静息和活动时NRS评分。记录术后48 h内补救镇痛例数。记录胸闷、低氧血症、气胸、切口感染、局麻药毒性反应、恶心呕吐、皮肤瘙痒等术后不良反应的发生情况。记录术后住院时间。
结果 与SB组比较，CB组入PACU后30 min、术后6、12、48 h静息和活动时NRS评分明显降低（P<0.05）。与SB组比较，CB组术后补救镇痛率明显降低（P＜0.05）。两组术后胸闷、低氧血症、气胸、皮肤瘙痒差异无统计学意义。两组无一例切口感染和局麻药毒性反应。两组术后住院时间差异无统计学意义。
结论 超声引导下肋间神经持续阻滞可为双孔胸腔镜手术患者提供满意的术后镇痛，较单次阻滞效果确切，不良反应更少。 |
| 英文摘要: |
Objective To investigate the effects of ultrasound-guided continuous intercostal nerve block on postoperative early recovery in patients undergoing two-port video-assisted thoracic surgery.
Methods Sixty patients undergoing two-port thoracoscopic lobectomy, 33 males and 27 females, aged 18-64 years, ASA physical status Ⅰ or Ⅱ, were recruited. They were randomly divided into two groups: continuous intercostal nerve block (group CB) and single intercostal nerve block combined with oral analgesia (group SB), 30 patients in each group. In group CB, the anesthesiologist performed ultrasound-guided catheterization at the intercostal space of thoracic drainage catheter after closing the chest and then connected the analgesic pump for continuous postoperative nerve block (0.2% ropivacaine and sufentanil 0.5 μg/ml diluted with normal saline to 200 ml, background dose 4 ml/h, PCA dose 4 ml, locking time 15 minutes). In group SB, the surgeon performed thoracoscopy-guided intercostal nerve block near the incision before closing the chest (0.5% ropivacaine 3 ml per intercostal space), and paracetamol tramadol tablets were given as postoperative oral analgesic. NRS scores were recorded at rest and activity 30 minutes after entering post-anesthesia care unit (PACU) and at 6, 12, 24, and 48 hours postoperatively. The number of remedial analgesia within 48 hours after operation was recorded. The occurrence of adverse reactions such as chest tightness, hypoxemia, pneumothorax, incision infection, local anesthetic toxicity, nausea and vomiting, and skin pruritus were recorded. Postoperative hospitalization time was recorded.
Results Compared with group SB, the NRS scores in group CB were significantly lower 30 minutes after entering PACU, 6, 12, and 48 hours after operation no matter at rest and activity (P < 0.05). Compared with group SB, the postoperative remedial analgesia rate and postoperative nausea and vomiting incidence in group CB were significantly lower (P < 0.05). Postoperative chest tightness, hypoxemia, pneumothorax and pruritus were not statistically significant between the two groups. There was no incisional infection and local anesthetic toxicity in both groups. There was no significant difference in postoperative hospitalization time between the two groups.
Conclusion Ultrasound-guided continuous intercostal nerve block can provide effective analgesia for patients after thoracoscopic lobectomy, and the effect is definite with fewer adverse reactions compared with a single block. |
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