超声辅助肋间神经阻滞在胸科手术中的应用

Application of Ultrasound Assisted Intercostal Nerve Block in Patients Undergoing Thoracic Operation

目的探讨超声辅助肋间神经阻滞在胸科手术中应用的价值。方法选择单纯左胸第6-7肋骨切口的食管下段癌根治术70例,ASAⅠ-Ⅱ级,随机分为U组和C组,每组35例。U组全麻诱导前根据手术区域先行患侧超声引导下肋间神经阻滞,C组直接全麻插管。术中根据血压、心率调节全麻药的用量,手术结束时记录丙泊酚和舒芬太尼用量及全麻后患者的苏醒时间。术后镇痛U组采用超声引导下肋间神经阻滞,C组应用静脉泵术后镇痛,观察术后2（T1）、4（T2）、12（T3）、24 h（T4）的镇痛效果及术后恶心、呕吐的发生情况。结果 U组术中丙泊酚、舒芬太尼用量明显少于C组[（656.5±32.3）mg vs.（845.8±47.0）mg,t=-19.638,P=0.000;（48.3±11.3）μg vs.（69.7±13.5）μg,t=-7.191,P=0.000]。U组清醒时间（18.5±3.8）min,明显短于C组（28.7±4.3）min（t=-10.516,P=0.000）。U组在T1、T2、T3时点VAS明显低于C组[T1：（2.3±0.8）分vs.（3.0±1.2）分,t=-2.871,P=0.005;T2：（1.8±0.7）分vs.（2.8±1.2）分,t=-4.258,P=0.000;T3：（1.5±0.5）分vs.（2.6±0.9）分,t=-6.321,P=0.000],T4无统计学差异[（1.1±0.3）分vs.（1.1±0.4）分,t=0.000,P=1.000]。术后恶心发生率C组高于U组[28.6%（10/35）vs.5.7%（2/35）,χ^2=6.437,P=0.011]。C组呕吐1例,U组无发生,无统计学差异（Fisher’s检验,P=1.000）。结论超声辅助肋间神经阻滞应用在胸科手术能够减少术中麻醉用药,术后镇痛效果良好,减少术后恶心的发生率。

Objective To investigate the application value of ultrasound assisted intercostal nerve block in thoracic operations. Methods A total of 70 cases of esophageal carcinoma treated by radical resection via a left thoracic 6- 7 rib incision in our hospital were selected. The patients were classified as ASA Ⅰ- Ⅱ. They were randomly divided into U group and C group,with35 cases in each group. The U Group was given intercostal nerve block under ultrasound guidance according to the operation area before the induction of anesthesia. The C group was given direct anesthesia intubation. According to intraoperative blood pressure and heart rate,the amount of anesthetics was adjusted. At the end of the operation,the amount of propofol and sufentanil anesthesia,and patients＇ recovery time were recorded. Postoperative analgesia included ultrasound-guided intercostal nerve block in the U Group and intravenous postoperative analgesia pump in the C Group. The analgesic effects at 2 h（ T1）,4 h（ T2）,12 h（ T3）,and 24 h（ T4）,as well as complications of postoperative nausea and vomiting,were observed. Results The dosage of propofol and sufentanil in the U Group was less than that in the C Group [（ 656. 5 ± 32. 3） mg vs.（ 845. 8 ± 47. 0） mg,t =- 19. 638,P = 0. 000;（ 48. 3 ± 11. 3）μg vs.（ 69. 7 ± 13. 5） μg,t =- 7. 191,P = 0. 000]. The awake time was significantly shorter in the U Group（ 18. 5 ± 3. 8） min than that in the C Group [（ 28. 7 ± 4. 3） min,t =- 10. 516,P = 0. 000]. In the U Group,the VAS scores at T1,T2,and T3 were significantly lower than those of the C Group [T1：（ 2. 3 ± 0. 8） points vs.（ 3. 0 ± 1. 2） points,t =- 2. 871,P = 0. 005; T2：（ 1. 8 ±0. 7） points vs.（ 2. 8 ± 1. 2） points,t =- 4. 258,P = 0. 000; T3：（ 1. 5 ± 0. 5） points vs.（ 2. 6 ± 0. 9） points,t =- 6. 321,P =0. 000]. However,the VAS scores at T4 were not statistically different between the two groups [（ 1. 1 ± 0. 3） points vs.（ 1. 1 ± 0. 4）points,t = 0. 000,P = 1. 000]. The incidence of postoperative nausea was higher in the C Group than that in the U Group [28. 6%（ 10/35） vs. 5. 7%（ 2/35）,χ^2= 6. 437,P = 0. 011]. Vomiting happened in 1 case in the C Group,while none in the U Group,without statistical difference（ Fisher ＇s test,P = 1. 000）. Conclusion Ultrasound assisted intercostal nerve block in thoracic surgerycan reduce intraoperative anesthetic use,obtain good postoperative analgesic effects,and reduce the incidence of postoperative nausea.