超声引导下SAPB与TPVB对胸腔镜下肺叶切除术后镇痛效果的比较

Comparison of Postoperative Analgesic Effect of SAPB and TPVB under Ultrasound Guidance in Patients Undergoing Thoracoscopic Lobectomy

目的比较超声引导下前锯肌平面阻滞(SAPB)与胸椎旁神经阻滞(TPVB)对胸腔镜下肺叶切除术后的镇痛效果。方法回顾性分析2017年1月至2019年12月内江市第一人民医院收治的113例择期行胸腔镜下肺叶切除术患者的临床资料,按照镇痛方式不同分为SAPB组(57例)和TPVB组(56例),SAPB组患者行超声引导下SAPB,TPVB组患者行超声引导下TPVB。比较两组患者术中阿片类药物用量、麻醉后监测治疗室(PACU)停留时间,气管导管拔出30 min(T_(1))、术后12 h(T_(2))、术后24 h(T_(3))、术后36 h(T_(4))的疼痛视觉模拟评分(VAS)、Ramsay镇静评分,以及恶心呕吐、血肿、气胸等不良反应发生情况。结果术中,SAPB组患者瑞芬太尼、舒芬太尼用量均明显少于TPVB组[(275.4±20.6)μg比(304.4±22.4)μg,(55.1±1.9)μg比(59.0±1.2)μg](P <0.01);SAPB组患者PACU停留时间明显短于TPVB组[(40.0±3.9) min比(43.7±4.8) min](P <0.01)。静息状态和咳嗽状态VAS评分的组间与时点间存在交互作用(P <0.01),SAPB组T_(2)时点静息状态和咳嗽状态VAS评分明显低于TPVB组(P <0.05),而T_(4)时点静息状态和咳嗽状态VAS评分明显高于TPVB组(P <0.05)。不同时点间Ramsay镇静评分的主效应差异有统计学意义(P <0.01),组间与时点间不存在交互作用(P> 0.01)。TPVB组总不良反应发生率为12.50%(7/56),SAPB组为3.51%(2/57),两组总不良反应发生率比较差异无统计学意义(P> 0.05)。结论与超声引导下TPVB相比,超声引导下SAPB可降低术后24 h内疼痛评分,且能够达到与超声引导下TPVB相同的镇静效果,操作相对简便。

Objective To compare the postoperative analgesic effect of ultrasound-guided serratus anterior plane block( SAPB) and thoracic paravertebral block( TPVB) on thoracoscopic lobectomy. Methods Retrospective analysis was performed on the clinical data of 113 patients admitted to Neijiang First People’s Hospital from Jan. 2017 to Dec. 2019 for elective thoracoscopic lobectomy. According to different analgesic methods,the patients were divided into a SAPB group( 57 cases) and a TPVB group( 56 cases). The SAPB group received ultrasound-guided SAPB and the TPVB group received ultrasound-guided TPVB. Intraoperative opioid consumption,postanesthesia care unit( PACU) stay,pain visual analogue scale( VAS),Ramsay sedation scores,at 30 min after endotracheal tube pull( T_(1)),12 h after surgery( T_(2)),24 h after surgery( T_(3)) and 36 h after surgery( T_(4)),and adverse reactions such as nausea and vomiting,hematoma,pneumothorax of the two groups were compared. Results Intraoperatively,the dosages of remifentanil and sufentanil in the SAPB group were significantly lower than those in the TPVB group[( 275. 4 ± 20. 6) μg vs( 304. 4 ± 22. 4) μg,( 55. 1 ± 1. 9) μg vs( 59. 0 ± 1. 2) μg]( P < 0. 01). The PACU stay time in the SAPB group was significantly shorter than that in the TPVB group[( 40. 0 ± 3. 9) min vs( 43. 7 ± 4. 8) min]( P < 0. 01). VAS scores for resting state and cough state at T_(2) of the SAPB group were significantly lower than those in the TPVB group( P < 0. 05),while at T_(4) were significantly higher( P < 0. 05). The main effect of Ramsay sedation score at different time points was statistically significant( P <0. 01),and there was no interaction between the groups and the time points( P > 0. 01). The incidence of total adverse reactions was 12. 50 %( 7/56) in the TPVB group and 3. 51 %( 2/57) in the SAPB group,which were not statistically significantly different( P > 0. 05). Conclusion Compared with ultrasound-guided TPVB,ultrasound-guided SAPB can reduce postoperative pain score within 24 h,and achieve the same sedative effect as ultrasound-guided TPVB with relatively simple operation.