连续前锯肌平面阻滞对胸腔镜下肺癌根治术患者术后肺氧合功能的影响

Effect of continuous serratus anterior plane block on postoperative pulmonary oxygenation function in patients with radical resection of lung cancer under thoracoscopic surgery

目的比较连续前锯肌平面阻滞(SAPB)和静脉自控镇痛(PCIA)两种镇痛方式在胸腔镜下肺癌根治术患者术后减少肺部并发症、改善肺氧合功能方面的有效性。方法择期行胸腔镜下肺癌根治术患者126例,年龄18~70岁,BMI 18.5~30.0 kg/m2,ASAⅠ–Ⅲ级,随机分为两组:连续SAPB组(S组)和PCIA组(P组),每组63例。术毕S组行超声引导下前锯肌平面阻滞,注入0.375%罗哌卡因20 ml,留置导管予0.2%罗哌卡因行自控镇痛;P组行舒芬太尼常规PCIA。麻醉诱导前(T0)、术毕即刻(T1)、拔管后2 h(T2)、拔管后6 h(T3)、拔管后24 h(T4)抽取桡动脉血记录PaO2并计算氧合指数(OI)。记录T2-T4时静态和活动VAS评分,并记录肺部并发症发生情况。结果与T0时比较,T2、T3时两组OI明显降低,且P组明显低于S组(P<0.05)。T2-T4时S组VAS评分明显低于P组(P<0.05),但两组补救镇痛例数差异无统计学意义。与P组比较,S组低氧血症、肺不张、恶心、呕吐的发生率明显降低(P<0.05)。结论连续SAPB较PCIA能够改善胸腔镜下肺癌根治术患者肺氧合功能。

Objective To compare the efficacy of continuous serratus anterior plane block and patient-controlled intravenous analgesia(PCIA)in reducing pulmonary complications and improving pulmonary oxygenation function in patients with radical resection of lung cancer under thoracoscopic surgery.Methods A total of 126 patients undergoing thoracoscopic radical resection of lung cancer were enrolled,aged 18-70 years old,BMI 18.5-30.0 kg/m 2,falling into ASA physical statusⅠ-Ⅲ.Patients were randomly divided into two groups:continuous serratus anterior plane block group(group S,n=63)and patient-controlled intravenous analgesia group(group P,n=63).In group S,serratus anterior plane block was performed under the guidance of ultrasound after surgery,20 ml of 0.375%ropivacaine as the first dose was followed by a continuous infusion of 0.2%ropivacaine.In group P,PCIA was provided accordingly.To calculate the oxygenation index(OI)with the arterial oxygen partial pressure(PaO 2),blood samples from radial artery were taken for blood gas analysis at following time points:before anesthesia(T 0),end of surgery(T 1),2 h(T 2),6 h(T 3)and 24 h after extubation of tracheal tube(T 4).Postoperative resting and active visual analogue scale(VAS)were recorded at T 2-T 4.The incidence of pulmonary complications was also recorded.Results Compared with T 0,value of OI at T 2 and T 3 was obviously declined in both groups(P<0.05),with a significantly lower value of OI in group P(P<0.05).The value of OI at T 4 in group P consistently declined,and was lower than that in group S(P<0.05).Group S had less incidence of adverse events,such as hypoxia,atelectasis,nausea and vomiting(P<0.05).Conclusion Continuous serratus anterior plane block,comparing with patient-controlled intravenous analgesia,can improve the pulmonary oxygenation function in patients after thoracoscopic radical resection of lung cancer.