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| 前锯肌平面阻滞对心肺转流下胸腔镜心脏手术患者应激反应和术后镇痛的影响 |
| Effect of serratus anterior plane block on stress response and postoperative analgesia in patients undergoing thoracoscopic cardiac surgery under cardiopulmonary bypass |
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| DOI：10.12089/jca.2022.10.011 |
| 中文关键词: 超声引导 前锯肌平面阻滞 心肺转流 胸腔镜心脏手术 应激反应 术后镇痛 |
| 英文关键词: Ultrasound guidance Serratus anterior plane block Cardiopulmonary bypass Thoracoscopic cardiac surgery Stress response Postoperative analgesia |
| 基金项目:江西省教育厅科学技术研究项目（GJJ170035） |
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| 中文摘要: |
目的 探讨前锯肌平面阻滞（SAPB）对心肺转流（CPB）下胸腔镜心脏手术患者应激反应和术后镇痛的影响。
方法 选择2018年1月至2019年3月行CPB下胸腔镜心脏手术患者40例，男25例，女15例，年龄18～64岁，BMI 18～28 kg/m2，ASA Ⅲ级。采用随机数字表法分为两组：SAPB组(S组)和对照组(C组)，每组20例。S组于麻醉诱导前行超声引导下SAPB，在前锯肌表面缓慢注射0.5%罗哌卡因20 ml，30 min后测定阻滞效果，满意后实施全凭静脉麻醉。C组不做处理。两组采用相同的全凭静脉麻醉方法，术毕均行静脉自控镇痛。分别于麻醉诱导前（T1）、CPB前（T2）、CPB结束时（T3）、手术结束时（T4）、手术结束后24 h（T5）抽取静脉血，测血浆皮质醇（Cor）、肾上腺素（E）、血糖（Glu）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）的浓度。记录术中及术后24 h舒芬太尼的用量、苏醒时间、气管拔管时间、心胸外科重症监护室（ICU）停留时间、术后24 h的VAS疼痛评分以及术后并发症发生情况。
结果 与T1时比较，T2—T5时两组血清Cor、E、Glu、IL-6浓度明显升高，血清IL-10浓度明显降低（P＜0.05）。与C组比较，T2—T5时S组Cor、E、Glu、IL-6浓度明显降低，IL-10浓度明显升高，术中及术后24 h舒芬太尼用量明显减少，术后24 h静息和活动时VAS疼痛评分明显降低，苏醒时间、气管拔管时间、心胸外科ICU停留时间明显缩短（P＜0.05）。两组术后恶心呕吐、肺部感染、低氧血症、肾功能失代偿等并发症发生率差异无统计学意义。
结论 对心肺转流下胸腔镜心脏手术患者实行超声引导前锯肌平面阻滞联合全凭静脉麻醉，可明显降低应激反应，术后镇痛效果更好。 |
| 英文摘要: |
Objective To investigate the effect of serratus anterior plane block (SAPB) on stress response and postoperative analgesia in patients undergoing thoracoscopic cardiac surgery under cardiopulmonary bypass (CPB).
Methods Forty patients undergoing thoracoscopic cardiac surgery under CPB from January 2018 to March 2019, 25 males and 15 females, aged 18-64 years, BMI 18-28 kg/m2, ASA physical status Ⅲ, were randomly divided into two groups: SAPB combined with general anesthesia group (group S) and control group (group C), 20 patients in each group. In group S, ultrasound-guided SAPB was performed and 0.5% ropivacaine 20 ml was given before anesthesia induction. After 30 min, the blocking effect was measured and total intravenous anesthesia was performed. Patients in group C did not undergo such treatment. The total intravenous anesthesia methods were the same in both groups. Patients in both groups received intravenous self-controlled analgesia after surgery. Venous blood was drawn before anesthesia (T1), before CPB (T2), at the end of CPB (T3), at the end of operation (T4), 24 hours after operation (T5), and plasma concentrations of cortisol (Cor), epinephrine(E), glucose (Glu), interleukin-6 (IL-6), interleukin-10 (IL-10) were measured. The dosage of sufentanil during operation and within 24 hours after operation were recorded. Awareness time, extubation time of tracheal tube, ICU stay time, adverse reactions were recorded. The VAS scores at 24 hours postoperatively were recorded.
Results Compared with T1, Cor, E, Glu, and IL-6 concentration in the two groups increased significantly at T2-T5; IL-10 concentration in the two groups decreased significantly at T2-T5(P < 0.05). Compared with group C, the concentration of Cor, E, Glu, and IL-6 in group S was significantly lower at T2-T5(P < 0.05), the concentration of IL-10 was significantly higher at T2-T5 (P < 0.05), the dosages of sufentanil during operation and within 24 hours after operation, the VAS scores in resting and active states at 24 hours postoperatively, awareness time, extubation time of tracheal tube, ICU stay time were significantly lower in group S (P < 0.05). There were no significant differences in the incidences of postoperative complications such as nausea, vomiting, lung infections, hypoxemia, and decompensated renal function between the two groups.
Conclusion Ultrasound-guided serratus anterior plane block combined with total intravenous anesthesia for patients undergoing thoracoscopic cardiac surgery under CPB can significantly reduce stress response, and provide better effect of postoperative analgesia. |
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