超声引导下前锯肌肋间神经阻滞在胸外科手术中的应用

Application of ultrasound-guided serratus anterior intercostal nerve block in thoracic surgery

目的:探讨超声引导下前锯肌肋间神经阻滞在胸外科手术中的应用效果。方法:选取2018年7月-2020年1月行胸外科手术的患者100例,随机分为两组,各50例。两组患者术前常规禁饮4 h,禁食6 h,均采用静吸复合全身麻醉。麻醉诱导:面罩吸氧后静脉输注舒芬太尼0.5μg/kg、丙泊酚1.5 mg/kg、维库溴铵0.1 mg/kg。麻醉维持:静脉泵入丙泊酚2 mg/(kg·h)、瑞芬太尼0.2μg/(kg·min),吸入0.8MAC七氟醚,间断给维库溴铵维持肌松,手术结束缝皮前开启静脉自控镇痛(PCIA),PCIA配方:舒芬太尼1μg/mL加甲氧氯普胺10 mg,生理盐水稀释至100 mL,背景剂量2 mL/h,单次自控剂量1 mL,锁定时间15 min。观察组于麻醉诱导后在超声引导下行术侧前锯肌神经阻滞操作:采用彩色多普勒超声诊断仪,超声探头线性频率为10~13 MHz,定位于术侧第4~9肋间水平获取清晰的背阔肌、前锯肌图像。应用22G神经阻滞针行相应手术区域平面内穿刺进针,超声实时引导下确认针尖到达前锯肌间隙,回抽无血无气后注射0.375%罗哌卡因20~30 mL进行阻滞,在相应手术区域行肋间神经阻滞推注0.375%罗哌卡因5~10 mL。比较两组麻醉效果。结果:观察组术中及术后舒芬太尼用量明显低于对照组,差异有统计学意义(P<0.05);观察组静脉自控镇痛按压次数明显高于对照组,且术后苏醒时间明显低于对照组,差异有统计学意义(P<0.05);观察组术后24 h恢复质量评分(QoR-40)明显高于对照组,视觉模拟疼痛评分明显低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下前锯肌肋间神经阻滞在胸外科手术中的麻醉效果显著。

Objective:To investigate the effect of ultrasound-guided serratus anterior intercostal nerve block in application of thoracic surgery.Methods:From July 2018 to January 2020,100 cases of patients who underwent thoracic surgery were enrolled,they were randomly divided into two groups with 50 cases in each group.Patients in both groups were given a combination of aspiration and general anesthesia.Anesthesia induction:intravenous infusion of sufentanil 0.5 g/kg,propofol 1.5 mg/kg and vecuronium 0.1 mg/kg after oxygen mask inhalation.Maintenance of anesthesia:propofol 2 mg/(kg·h)and Remifentanil 0.2 g/(kg·min)were injected intravenally,0.8Mac sevoflurane was inhaled,and intravenous controlled analgesia(PCIA)was opened before the end of suture.After anesthesia induction,the observation group underwent anterior serratus nerve block operation under ultrasound guidance:at the intercostal level 4-9 of the operative side,0.375%ropivacaine 20-30 mL was injected to block,and the anesthetic effect of the two groups was compared.Results:The dosage of sufentanil in the observation group was significantly lower than that in the control group during and after the operation,the differences were statistically significant(P<0.05).The frequency of pressing intravenous auto-control analgesia in the observation group was significantly higher than that in the control group,the postoperative recovery time was significantly lower than that in the control group,the differences were statistically significant(P<0.05).The score of quality of recovery(QoR-40)of 24 h after operation in the observation group was significantly higher than that in the control group,the visual analogue pain score was significantly lower than the control group,the differences were statistically significant(P<0.05).Conclusion:The anesthesia effect of ultrasound-guided serratus anterior intercostal nerve block in thoracic surgery is remarkable.