开胸肺叶切除术后超声引导下连续竖脊肌平面阻滞的镇痛效果

Analgesic efficacy of ultrasound guided CESPB after thoracotomy pulmonary lobectomy

目的探讨超声引导下连续竖脊肌平面阻滞(continuous erector spinal plane block,CESPB)在开胸肺叶切除术后的镇痛效果。方法择期行开胸肺叶切除术患者60例,ASAⅠ或Ⅱ级。随机分为CESPB组(CE组)和单纯PCIA组(P组),每组30例。CE组麻醉诱导前行ESP阻滞,15 min后测定阻滞范围,术毕CE组采用连续竖脊肌平面阻滞镇痛,而P组采用PCIA。记录术后1 h、6 h、12 h、24 h和48 h静息和咳嗽时VAS评分,镇痛泵按压次数,氟比洛芬酯用药总量,患者满意度以及术后不良反应发生情况。结果 CE组,ESPB 15 min后可阻滞T2～T9脊神经支配区域,术后1～48 h CE组静息和咳嗽时VAS评分明显低于P组(P<0.05),镇痛泵按压次数和氟比洛芬酯用药总量明显少于P组(P<0.05)。两组术后恶心、呕吐发生率差异无统计学意义。结论超声引导下连续竖脊肌平面阻滞镇痛在开胸肺叶切除术中较单纯PCIA方式更为安全有效。

Objective To explore the analgesic effect of ultrasound guided continuous erector spinal plane block ( CESPB ) after thoracotomy pulmonary lobectomy. Methods The 60 patients subject to schemed thoracotomy lung resection , ASA Ⅰ or Ⅱ grade , were randomly divided into CESPB group ( CE group ) and simple PCIA group ( P group ), 30 cases in each group. In CE group , ESPB was induced by anesthesia , after 15min , the block range was determined. After surgery CE group used CESPB for analgesia , while PCIA was used in P group. The VAS score at 1h , 6h , 12h , 24h and 48h when cough and rest after surgery , the pressure times on analgesic pump , the total dosage of flurbiprofen ester , the patient satisfaction degree and the postoperative adverse reactions were recorded. Results In CE group ESP block for 15 min could make the blockade of T 2 -T 9 spinal nerve control area , at 1-48h after surgery when rest and cough VAS score was lower than that in P group ( P<0.05 ), time- number of analgesia pump pressure and the total dosage of flurbiprofen ester were significantly less than in P group ( P<0.05 ). The incidence of postoperative nausea and vomiting had no statistical significance. Conclusion Ultrasound guided CESPB is more safer and effective than the alone PCIA in thoracic lobectomy.