竖脊肌平面阻滞自控镇痛在胸科加速康复中的应用

Application of continuous erector spinae plane block with patient-controlled analgesia in enhanced recovery after thoracic surgery

目的探讨超声引导持续竖脊肌平面阻滞自控镇痛在胸科术后镇痛中的效果及对术后快速康复的影响。方法选择行择期胸腔镜手术患者150例,按随机数字表法分为竖脊肌平面阻滞自控镇痛组(N组)和静脉自控镇痛组(I组),每组75例。N组行超声引导竖脊肌平面阻滞,注入0.2%罗哌卡因35ml,留置导管予0.2%罗哌卡因自控镇痛,自控背景剂量4ml/h,单次剂量5ml/次,锁定时间15min。I组则予舒芬太尼1μg/ml静脉自控镇痛,自控背景剂量2ml/h,单次剂量3ml/次,锁定时间15min。记录并比较两组患者术后1h(T1)、4h(T2)、8h(T3)、24h(T4)、2d(T5)、3d(T6)、4d(T7)、30d(T8)、60d(T9)Prince-Henry疼痛评分(PHPS)和Bruggrmann舒适度评分(BCS);术后初次下床活动、肛门排气、肛门排便、拔除胸管及办理出院时间;睡眠质量、不良反应、慢性疼痛发生情况。结果与I组比较,N组在T1、T3~T7时点PHPS评分更低(均P<0.01);而在T1、T3~T7时点和T9时点BCS评分更高(P<0.01或0.05)。N组患者术后初次下床活动、肛门排气、肛门排便时间更早,办理出院时间提前,且术后第1~4夜睡眠质量评分更佳,而不良反应和术后慢性疼痛发生率也更低,差异均有统计学意义(P<0.01或0.05)。结论超声引导竖脊肌平面阻滞自控镇痛可显著减轻胸腔镜手术后疼痛,改善睡眠,减少不良反应,降低术后慢性疼痛发生,加快术后康复。

Objective To evaluate the application of continuous erector spinae plane block with patient-controlled analgesia(PCA)for postoperative analgesia in fast rehabilitation after thoracic surgery.Methods 150 patients scheduled for thoracoscopic surgery were randomly divided into group N and group I.Patients in group N(n=75)received ultrasound-guided continuous erector spinae plane block with PCA.The first dose for PCA was 0.2%ropivacaine and 35ml of 0.2%ropivacaine,the PCA pump was set up with a 5 ml bolus dose,a 15 min lockout interval and a background infusion at the rate of 4 ml/h.Patients in group I(n=75)received patient-controlled intravenous analgesia,with continuous infusion of sufentanil(1μg/ml).The PCA pump was set up with a 3 ml bolus dose,a 15 min lockout interval and a background infusion at the rate of 2 ml/h.Postoperative Prince-Henry pain scale(PHPS)and Bruggrmann comfort scale(BCS)were recorded at 1h(T1),4h(T2),8h(T3),24h(T4),2d(T5),3d(T6),4d(T7),30d(T8),60d(T9)after surgery.The time of postoperative first off-bed activity,passage of gas by anus,bowel movement,chest tube removal,discharge from hospital were recorded.Moreover,sleep quality scale,adverse reactions and chronic pain were also recorded.Results The PHPS score was lower in group N at T1 and T3~T7 compared with group I(all P<0.01).Compares to group I,the BCS score was higher in group N at T1,T3~T7(all P<0.01)and T9(P<0.05).And the time of off-bed activity,passage of gas by anus,bowel movement,discharge from hospital in group N was shorter than those in group I(P<0.01 or P<0.05).N group had better sleep quality from the first night to the 4th night(all P<0.01),and with lower incidence rate of adverse reactions and chronic pain.Conclusion The application of ultrasound-guided continuous erector spinae plane block after thoracoscopic surgery can reduce postoperative acute and chronic pain,reduce the rate of adverse reactions and improve sleep,so that to enhance recovery after surgery.