超声引导前锯肌平面阻滞麻醉在胸腔镜肺癌根治术中的应用

Application of Ultrasound-guided Serratus Anterior Plane Block Anesthesia in Thoracoscopic Radical Resection of Lung Cancer

目的:探讨超声引导前锯肌平面阻滞麻醉在胸腔镜肺癌根治术中的应用效果。方法:选择2019年1-12月在本院行胸腔镜肺癌根治术的患者60例。将患者随机分为研究组和对照组,每组30例。两组患者均行胸腔镜肺癌根治术,均采用静脉诱导麻醉,并在此基础上行超声引导前锯肌平面阻滞,对照组注入30 mL氯化钠注射液,研究组注入30 mL 0.3%罗哌卡因。比较两组术中瑞芬太尼、丙泊酚、舒芬太尼用量和48 h内镇痛泵有效按压次数,比较两组术后不同时间的静息、运动疼痛程度,比较两组不同时间的平均动脉压、心率情况,比较两组术后不良反应发生情况。结果:研究组48 h内镇痛泵有效按压次数和舒芬太尼、瑞芬太尼、丙泊酚使用剂量均少于对照组,差异均有统计学意义(P<0.05);术后24、48 h,两组的静息、运动疼痛评分比较,差异均无统计学意义(P>0.05);术后2、6、12 h,研究组的静息、运动疼痛评分均低于对照组,差异均有统计学意义(P<0.05)。入室时、麻醉诱导后5 min、切皮后2 min,两组平均动脉压、心率比较,差异均无统计学意义(P>0.05);术毕、拔管后10 min,研究组平均动脉压、心率均低于对照组,差异均有统计学意义(P<0.05)。研究组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:胸腔镜肺癌根治术患者应用0.3%罗哌卡因药物能够在一定程度上减少阿片类药物使用剂量,减轻患者术后早期疼痛程度,阻滞时间长达12 h,减少患者术后不良反应发生率,超声引导前锯肌平面阻滞麻醉中应用0.3%罗哌卡因药物安全简单,可作为围手术期镇痛的重要组成部分。

Objective:To investigate the application of ultrasound-guided serratus anterior plane block anesthesia in thoracoscopic radical resection of lung cancer.Method:A total of 60 patients who received thoracoscopic radical resection of lung cancer in our hospital from January to December 2019 were selected.The patients were randomly divided into study group and control group,30 cases in each group.Patients in both groups received thoracoscopic radical resection of lung cancer,intravenously induced anesthesia,and ultrasound-guided serratus anterior plane block on this basis.The control group was injected with 30 mL Sodium Chloride Injection,while the study group was injected with 30 mL 0.3% Ropivacaine.The amount of Remifentanil,Propofol and Sufentanil during surgery and the effective pressure times of analgesia pump within 48 h were compared between the two groups.The degree of pain in resting and exercise at different time after operation were compared between the two groups.The average arterial pressure and heart rate of the two groups at different time were compared,and the incidence of postoperative adverse reactions between the two groups was compared.Result:The number of effective pressure of analgesia pump and the dosage of Sufentanil,Remifentanil and Propofol in the study group were less than those in the control group within 48 h,the differences were statistically significant (P<0.05).24 and 48 h after surgery,scores of resting and exercise pain between two groups compared,there were no statistical significances between two groups (P>0.05).At 2,6 and 12 h after surgery,the scores of resting and exercise pain in the study group were lower than those in the control group,the differences were statistically significant (P<0.05).At the time of entry,5 min after induction of anesthesia,2 min after skin resection,comparison of average arterial pressure and heart rate between the two groups,there were no statistical significance between the two groups (P>0.05).At the end of surgery and 10 minutes after extubation,the average arterial pressure and heart rate in the study group were lower than those in the control group,the differences were statistically significant (P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion:The application of 0.3% Ropivacaine in thoracoscopic radical resection of lung cancer can reduce the dosage of opioids,relieve the early postoperative pain,block up to 12 h,and reduce the incidence of postoperative adverse reactions.The application of 0.3% Ropivacaine in ultrasound-guided serratus plane block anesthesia is safe and simple,it can be used as an important part of perioperative analgesia.