竖脊肌平面阻滞联合自控静脉镇痛在老年胸腔镜肺叶切除术中的应用

Erector spinae plane block combined with patient controlled subcutaneous analgesia in elderly thoraco⁃scopic lobectomy

目的探讨超声引导下单次竖脊肌平面阻滞(ESPB)联合自控静脉镇痛(PCIA)对胸腔镜下肺叶切除老年患者术后的镇痛效果。方法选择在全麻下行胸腔镜肺叶切除术的老年肺占位患者60例,ASAⅡ~Ⅲ级,随机分为单次ESPB联合PCIA组(EP组)30例和单纯PCIA组(P组)30例。EP组入预麻间后,0.5%罗哌卡因20 mL行单次ESPB,30 min后测定阻滞效果,P组予常规监测,不进行ESPB操作。术毕两组均接镇痛泵。记录两组术后入麻醉恢复室即刻(T0)、PACU期间最大(T1)、12 h时(T2)、24 h时(T3)、48 h时(T4)安静、咳嗽状态下视觉模拟评分(VAS);记录T0~T2、T2~T3、T3~T4时段内静脉镇痛泵的有效按压次数;记录T0~T3、T3~T4时段内追加镇痛药物例数;记录恶心呕吐、呼吸抑制等不良反应发生例数;记录肺不张、肺部感染发生例数;计算患者对镇痛效果的总满意率。结果EP组安静、咳嗽时VAS低于P组,镇痛泵的有效按压次数、镇痛药物术后追加患者比例均少于P组(P均<0.05)。EP组恶心、呕吐及肺不张、肺部感染的发生率均低于P组(P均<0.01)。EP组总满意率高于P组(P<0.01)。结论与单纯PCIA相比,超声引导下单次ESPB联合PCIA对行胸腔镜肺切除术老年患者的镇痛效果更佳,术后不良反应少,患者满意率更高。

Objective To investigate the effect of ultrasound-guided single erector spinae plane block(ESPB)combined with patient controlled intravenous analgesia(PCIA)on postoperative analgesia in elderly patients with thoracoscopic lobectomy.Methods Sixty elderly patients with occupied lung under total anesthesia who underwent thoracoscopic lobectomy and ASA class II-III were enrolled.All patients were randomly divided into two groups:single ESPB combined with PCIA group(EP group,30 cases)and PCIA group alone(P group,30 cases).A dose of 20 mL 0.5%ropivacaine was used for single ESPB in the EP group after entering the preanesthesia interval,and the block effect was measured after 30 min.P group received routine monitoring and no ESPB operation.After surgery,both groups were connected to analgesic pumps.Record the visual analogue score(VAS)of the two groups in the postanesthesia care unit(PACU)immediately(T0),maximum during PACU(T1),12 h(T2),24 h(T3),48 h(T4)under quiet and coughing state;the effective pressing times of intravenous analgesic pump during T0-T2,T2-T3 and T3-T4 were recorded;record the number of cases of additional analgesic drugs during T0-T3 and T3-T4;the number of cases of adverse reactions such as nausea,vomiting and respiratory depression;the number of cases of pulmonary insufficiency and pulmonary infections,and the overall satisfaction rate of patients with the analgesic effect were calculated.Results The VAS of EP group was lower than that of P group under quiet and coughing state(P<0.05).The effective pressing times of analgesia pump and the proportion of additional patients with analgesic drugs after operation were less than those of group P(P<0.05).The incidence of nausea,vomiting,pulmonary insufficiency and pulmonary infection was lower in the EP group than in the P group(P<0.01),and the overall satisfaction rate was higher in the EP group than that in the P group(P<0.01).Conclusion Compared to PCIA alone,ultrasound-guided single ESPB combined with PCIA provides better analgesia effects,fewer adverse reactions,and higher patient satisfaction rate.