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| 胸骨旁肋间平面阻滞对非心肺转流冠状动脉旁路移植术患者术后肺部并发症的影响 |
| Effect of parasternal intercostal plane blocks on postoperative pulmonary complications in patients undergoing non-cardiopulmonary bypass coronary artery bypass graft surgery |
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| DOI：10.12089/jca.2025.11.002 |
| 中文关键词: 胸骨旁肋间平面阻滞 术后肺部并发症 冠脉搭桥术 非心肺转流 |
| 英文关键词: Parasternal intercostal plane blocks Postoperative pulmonary complications Coronary artery bypass graft surgery Non-cardiopulmonary bypass |
| 基金项目:国家自然科学基金面上项目（82071903）；徐州市重点研发项目（KC23146）；徐州市彭城英才项目（XWRCHT20220017） |
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| 中文摘要: |
目的：探讨胸骨旁肋间平面阻滞对胸骨正中切开非心肺转流冠状动脉旁路移植术患者术后肺部并发症（PPCs）的影响。
方法：选择胸骨正中切开非心肺转流冠脉搭桥手术的患者172例，男85例，女87例，年龄30～70岁，BMI 18～25 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：胸骨旁肋间平面阻滞组（P组）和对照组（C组），每组86例。两组患者均行全身麻醉，P组全麻后行胸骨旁肋间平面阻滞，注射0.25%罗哌卡因20 ml；C组操作同P组，注射等容量生理盐水。记录术后1周内PPCs的发生情况。记录术中舒芬太尼用量。记录术后1、2、3、4 d静息和活动时NRS疼痛评分。记录术前、术后1、7 d血清IL-6、IL-8的浓度。记录术后机械通气时间、ICU停留时间、术后住院时间及术后30 d死亡情况。
结果： 与C组比较，P组术后1周内PPCs发生率明显降低（P＜0.05），术中舒芬太尼用量明显减少（P＜0.05），术后1、2 d静息和活动时NRS疼痛评分明显降低（P＜0.05），术后1 d血清IL-6、IL-8浓度明显降低（P＜0.05），术后机械通气时间、ICU停留时间及术后住院时间均明显缩短（P＜0.05）。两组术后30 d死亡率差异无统计学意义。
结论：胸骨旁肋间平面阻滞能明显降低胸骨正中切开非心肺转流冠状动脉旁路移植术患者PPCs发生率，改善患者术后疼痛及降低炎性因子浓度。 |
| 英文摘要: |
Objective: To explore the effect of parasternal intercostal plane blocks on postoperative pulmonary complications (PPCs) in patients undergoing non-cardiopulmonary bypass coronary artery bypass graft surgery with median sternotomy.
Methods: A total of 172 patients, including 85 males and 87 females, aged 30-70 years, BMI 18-25 kg/m2, and ASA physical status Ⅱ or Ⅲ, underwent sternotomy and non-cardiopulmonary bypass coronary artery bypass graft surgery. The patients were divided into two groups using a random number table method: the parasternal intercostal plane block group (group P) and the control group (group C), 86 patients in each group. Both groups of patients underwent general anesthesia. Group P received nerve block after general anesthesia, was injected with 20 ml of 0.25% ropivacaine. The operation of group C is the same as that of group P, with injection of saline of equal volume. The occurrence of PPCs in patients within one week after surgery were recorded. The intraoperative sufentanil dosage was recorded. NRS pain scores at rest and during activity on postoperative 1 day, 2, 3, and 4 days were recorded. The concentrations of IL-6 and IL-8 before surgery and on postoperative 1 day and 7 days were recorded. Postoperative mechanical ventilation time, length of ICU stay and postoperative hospital stay, and postoperative 30 days mortality were also recorded.
Results: Compared with group C, the incidence of PPCs in group P was significantly reduced (P < 0.05), the use of sufentanil during surgery was significantly reduced (P < 0.05), the NRS scores at rest and during activity pain were significantly reduced on postoperative 1 day and 2 days, and the concentrations of IL-6 and IL-8 were significantly reduced on postoperative 1 day (P < 0.05). The duration of mechanical ventilation, ICU stay, and hospitalization were all significantly shortened after surgery (P < 0.05). There was no statistically significant difference in postoperative 30 days mortality rate between the two groups.
Conclusion: Parasternal intercostal plane blocks can significantly reduce the incidence of PPCs, lower postoperative pain scores, and lower the concentration of inflammatory factors in patients undergoing non-cardiopulmonary bypass coronary artery bypass graft surgery with median sternotomy. |
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