超声引导下连续竖脊肌平面阻滞用于老年患者胸腔镜术后镇痛效果的研究

The observation of analgesic effect of ultrasound-guided continuous erector spinae plane block after thoracotomy in elderly patients

目的观察超声引导下连续竖脊肌平面(erector spinae plane,ESP)阻滞用于老年患者胸腔镜术后镇痛效果。方法选择行胸腔镜下肺叶切除术的老年患者60例,年龄65~79岁,ASAⅡ~Ⅲ级,随机数字表法分为连续竖脊肌平面阻滞组(E组)和舒芬太尼静脉镇痛组(S组)。E组于术毕拔管后在超声引导下行连续竖脊肌平面阻滞,经导管注药0.2%罗哌卡因20 ml负荷量,镇痛泵配方为0.2%罗哌卡因300 ml,运行方案为6 ml/h;S组于术毕缝皮前开启经静脉自控镇痛,镇痛泵配方为舒芬太尼2μg/kg稀释至100 ml,运行方案为2 ml/h。采用VAS评分法评估镇痛效果,观察术后镇痛满意度、术后不良反应如恶心呕吐等发生率。结果 E组在超声引导下均顺利完成竖脊肌平面阻滞置管,未发生穿刺相关并发症;与S组比较,E组术后6、12、24、48 h静息和运动VAS评分明显降低,镇痛效果好,满意度高(P<0.05),且未出现恶心、呕吐及嗜睡等不良反应,S组不良反应发生率为23.3%(P<0.05)。结论超声引导连续ESP阻滞用于老年患者胸腔镜手术术后镇痛效果确切,不良反应少。

Objective To observe the analgesic effect of continuous erector spinae plane （ESP） block after thoracotomy in elderly patients. Methods Sixty elderly patients scheduled for lobectomy under video-assisted thoracoscopic surgery, 65-79 years old, ASA Ⅱ-Ⅲ, were randomly allocated to ESPB group （group E） or sufentanil group （group S）, 30 patients in each group. Patients in group E received ultrasound-guided continuous ESP block after extubation. 20 ml loading dose of 0.2% ropivacaine were given through the catheter （PCNA formula： 300 ml 0.2% ropivacaine, 6 ml/h）. Patientcontrolled intravenous analgesia （PCIA） in group S was started at the time of suture （PCIA formula： sufentanil 2 μg/kg, 2 ml/h）. The VAS pain score was used to evaluate analgesic effect. Side effects such as nausea and vomiting, postoperative analgesia satisfaction were recorded. Results Group E were all successfully performed with coutinuous ESP block guided by ultrasound without puncture-related complications. Compared with group S, the VAS scores at 6, 12, 24, 48 h after the surgery in group E decreased significantly （P 〈 0.05）, with higher analgesia satisfaction （P 〈 0.05）. Group E showed no side effects such as nauseaand vomiting or drowsiness, while the incidence of side effects in group S was 23.3%. Conclusion Continuous erector spinae plane block guided by ultrasound in elderly patients provides adequate analgesic effect after thoracotomy with low incidence of side effects.