连续前锯肌阻滞对老年患者术后肺功能、镇痛及免疫功能的影响研究

Effect of anterior serratus muscle block guided with ultrasound on postoperative pulmonary function,analgesia and immune function in elderly patients with rib fractures

目的:探讨超声引导下前距肌连续阻滞镇痛对肋骨骨折老年患者术后肺功能、免疫功能及镇痛效果的影响。方法:选取老年肋骨骨折患者60例,随机分为静脉泵镇痛(对照组)30例和前锯肌连续阻滞镇痛(试验组)30例。两组患者入院后分别进行了肋骨骨折切开复位内固定术,对照组术毕给予静脉镇痛泵持续镇痛,试验组给予超声引导下前锯肌置管局麻药持续镇痛。比较两组患者术前12 h(T 0)、术后1 h(T 1)、24 h(T 2)、48 h(T 3)肺功能情况,包括最大通气量(MVV)、第1秒用力肺活量(FEV1)和用力肺活量(FVC),并测试两组患者各时间点深呼吸时VAS评分。测定两组患者各时间点血液中CD4^+水平、CD 8^+水平及CD 4^+/CD 8^+比值。结果:试验组在术后1 h(T 1)、24 h(T 2),MVV、FEV1、FVC高于对照组(P<0.05),在术后24 h(T 2)、48 h(T 3)VAS评分低于对照组(P<0.05)。试验组在术后1 h(T 1)、24 h(T 2)、48 h,患者体内CD 4^+水平及CD 4^+/CD 8^+比值高于对照组(P<0.05)。结论:超声引导下前距肌阻滞较静脉镇痛方式对肋骨骨折老年病人肺功能影响小、镇痛效果明显、且免疫抑制轻,是一种有效的胸科手术镇痛方式。

Objective:To investigate the effect of ultrasound-guided anterior muscle block on postoperative pulmonary function,analgesia and immune function in elderly patients with rib fractures.Methods:Sixty elderly patients with rib fractures were selected and randomly divided into 30 cases with intravenous analgetic pump(control group) and 30 cases with continuous serratus muscle blockade(experimental group).The two groups of patients were treated with open reduction and internal fixation of rib fracture after admission.The control group received continuous analgesia with intravenous analgesia pump.The experimental group received ultrasound-guided serratus muscle blockade for continuous analgesia through catheter connecting local anesthetic pump.The pulmonary function,including maximal ventilation(MVV),one second of forced vital capacity(FEV1) and forced vital capacity(FVC) were compared between two groups at following points,Twelve hours before surgery(T0),1 hour after surgery(T1),24 hours after surgery(T2),48 hours after surgery(T3),meanwhile the VAS scores when deep breathing were recorded.The levels of CD4^+ and CD4^+/CD8^+ of the two groups of patients were measured at each time point.Results:The scale of MVV,FEV1,and FVC in the serratus anterior blockade group were higher than those in the venous pump group at 1 hour(T1),24 hours(T2).The VAS score was lower than that in the venous pump group at 1 hour(T1),24 hours(T2)(P<0.05).At 1 hour(T1),24 hours(T2),and 48 hours(T3),the ratios of CD4^+ and CD4^+/CD8^+ in the anterior serratus group and venous pump group were significantly lower than that before anesthesia(T0)(P<0.05).In the anterior serratus group,the ratios of CD4^+ and CD4^+/CD8^+ were higher than the intravenous pump group at 1 hour(T1),24 hours(T2),and 48 hours after surgery(P<0.05).Conclusion:Ultrasound-guided anterior muscle block has a slight influence on lung function in elderly patients with rib fracture,simultaneously,providing more effective analgesia and less inhibition of immune function.It is an effective postoperative analgesic method for thoracic surgery.