连续竖脊肌平面阻滞与椎旁阻滞用于胸腔镜镇痛的比较

目的比较超声引导下连续竖脊肌平面(ESP)阻滞与连续椎旁阻滞在胸腔镜肺叶切除术中镇痛的有效性及安全性.方法择期胸腔镜肺叶切除患者64例,随机分为全身麻醉复合ESP阻滞置管术后镇痛组(E组)和全身麻醉复合胸椎旁神经阻滞置管术后镇痛组(P组).记录两组患者区域阻滞前(T0)、切皮时(T1)、切皮后5min(T2)、切皮后30min(T3)和术毕(T4)五个时间点的平均动脉压(MAP)和心率(HR).记录两组患者术毕(T5)、术后2h(T6)、术后6h(T7)、术后12h(T8)、术后24h(T9)和术后48h(T10)各观察时点的静息和咳嗽时VAS疼痛评分,观察并记录两组操作时间,患者术后补救镇痛例数、镇痛泵按压次数、患者镇痛满意度.比较两组术后恢复指标,包括首次进食时间、肛门排气时间、下床活动时间、术后胸腔引流管放置时间和术后住院天数.结果两组患者各时间点的平均动脉压(MAP)和心率(HR)差异无统计学意义(P>0.05),两组患者术后各时点安静和咳嗽时的疼痛评分差异无统计学意义(P>0.05),且两组各时点静息和咳嗽时的疼痛评分均<4分.两组患者补救镇痛例数、术后镇痛泵按压次数、患者满意度比较差异无统计学意义(P>0.05).E组镇痛操作时间明显短于P组,差异有统计学意义(P<0.05).两组术后恢复指标比较差异均无统计学意义(P>0.05).结论与椎旁阻滞比较,超声引导下连续ESP阻滞技术操作快捷,在胸腔镜肺叶切除术中可作为一种更理想的围术期镇痛方法.

Objective To compare continuous paravertebral block(PVB)with ultrasound-guided erector spinae plane(ESP)block for the perioperative pain management in patients undergoing lobectomy performed via video-assisted thoracoscopic surgery for the quality and safety of analgesia.Methods A total of 64 patients were enrolled,who were randomly divided into Group P(PVB group,n=32)and Group E(ESP group,n=32).Heart rate(HR)and mean arterial pressure(MAP)before regional block(TO),before skin incision(T1),at 5min after incision(T2),at 30min after incision(T3)and at the end of the surgery(T4)were recorded in both groups.Visual analog scale(VAS)during rest and cough was also recorded at Oh(T5),2h(T6),6h(T7),12h(T8),24h(T9)and 48h(T10)after operation.The operation time,number of patients using remedial analgesics,the number of postoperative analgesia pump pressure and analgesic satisfaction were recorded.The recovery indexes of the two groups were compared,including first postoperative feeding time,time of passing flatus,time to off-bed activities,postoperative placement time of chest tube,and length of postoperative hospital stay.Results MAP and HR of the two groups at TO,T1,T2,T3 and T4 had no significant difference(P>0.05).VAS scores during rest and cough at T5 to T10 time points after operation had no significant difference(P>0.05)and the mean VAS in either of the Group was less than 4.The block operation time of ESP group was significantly shorter than PVB group(P<0.05).Number of patients using remedial analgesics,the number of postoperative analgesia pump pressure,analgesic satisfaction all had no significant difference(P>0.05).All perioperative parameters had no significant difference(P>0.05).Conclusions Compared to continuous paravertebral block,ultrasound-guided erector spinae plane(ESP)block is faster to perform and can serve as a promising alternative in perioperative pain management in thoracoscopic lobectomy.