超声引导下前锯肌联合竖脊肌平面阻滞对电视辅助胸腔镜手术后早期恢复的影响

Effect of ultrasound-guided serratus anterior plane block combined with erector spine plane block on early recovery after video-assisted thoracoscopic surgery

目的探讨超声引导下前锯肌平面阻滞(SAPB)联合竖脊肌平面阻滞(ESPB)对行电视辅助胸腔镜手术(VATS)患者术后早期恢复的影响。方法选择2019年3~11月于陆军军医大学第二附属医院胸外科行VATS的患者144例,根据神经阻滞部位的不同随机分为竖脊肌平面阻滞组(EP组)、前锯肌平面阻滞组(SP组)、竖脊肌联合前锯肌平面阻滞组(ESP组)和对照组(C组),每组36例。观察记录所有患者术后24 h、48 h恢复质量(QoR-15)评分、患者满意度、术后第一晚睡眠质量VAS、监护室停留时间、胸管拔除时间、尿管拔除时间、首次下床活动时间、术后肺部并发症、恶心呕吐发生情况以及住院时间等。结果术后24 h、48 h QoR-15评分ESP组和SP组高于EP组、C组,两两比较差异均具有极显著性统计学意义(P<0.01),但ESP和SP组比较差异无统计学意义(P>0.05)。与C组相比,ESP组明显改善了术后第一晚睡眠质量VAS评分,同时也缩短了术后监护室停留时间、胸管拔除时间、尿管拔除时间、首次下床活动时间及住院时间(P<0.05);与SP组相比,ESP组在提高患者满意度的同时也缩短了住院时间(P<0.05)。各组患者术后肺部并发症及恶心呕吐发生率比较,差异无统计学意义(P>0.05)。结论超声引导下前锯肌联合竖脊肌平面阻滞可以促进VATS患者术后早期恢复,尤其在提高患者满意度和缩短住院时间方面优于前锯肌平面阻滞或竖脊肌平面阻滞。

Objective To observe the effect of ultrasound-guided serratus anterior plane block(SAPB)combined with erector spinae plane block(ESPB)on early recovery after video-assisted thoracoscopy(VATS).Methods A total of 144 patients who underwent VATS in the Thoracic Surgery Department of the Second Affiliated Hospital of Army Medical University from March to November 2019 were randomly divided into the erector spinae plane block group(EP group)and serratus anterior plane block group(SP group),erector spinae combined with serratus anterior plane block group(ESP group)and control group(C group),36 cases in each group.The quality of recovery(QoR-15)score at 24 hours and 48 hours after surgery,the VAS score of sleep quality on the first night after surgery,the length of stay in the intensive care unit,the time of chest tube and urinary tube removal,the first time out-of-bed activity time,postoperative pulmonary complications and nausea and vomiting were observed and recorded.Results The QoR-15 scores in ESP group and SP group at 24 hours and 48 hours were higher than those in EP group and C group,the differences were statistically significant of pairwise comparisons(P<0.01),but there was no significant difference between ESP group and SP group(P>0.05).Compared with C group,ESP group significantly improved the VAS score of the first night′s sleep quality,and also shortened the patient′s postoperative intensive care unit stay time,chest tube removal time,urinary tube removal time,and first time out-of-bed activity time and average hospital stay(P<0.05).Compared with SP group,ESP group shortened the average hospital stay and improved patients′satisfaction(P<0.05).There was no statistically significant difference in postoperative pulmonary complications,nausea and vomiting among the four groups(P>0.05).Conclusion Ultrasound-guided erector spinae combined with anterior serratus block can promote early recovery after VATS,which is better than simple serratus anterior or erector spinae block in improving patients′satisfaction and shortening the hospital stay.