胸腔镜肺大疱切除手术的麻醉策略:超声引导菱形肌-肋间肌-低位前锯肌平面阻滞联合全身麻醉

Modified strategy of anesthesia for thoracoscopic pulmonary bullae resection:ultrasound-guided rhomboid intercostal and subserratus plane block combined with general anesthesia

目的评价超声引导菱形肌-肋间肌-低位前锯肌平面阻滞联合全身麻醉用于胸腔镜肺大疱切除手术患者的麻醉镇痛效果。方法选取择期行胸腔镜肺大疱切除手术患者70例,性别不限,年龄18~60岁,美国麻醉医师协会分级(American Society of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,随机分为阻滞联合全身麻醉组(R组)和单纯全身麻醉组(G组),每组35例。R组在麻醉诱导前实施患侧菱形肌-肋间肌-低位前锯肌平面阻滞(rhomboid intercostal and subserratus plane block,RISS),G组不进行干预。2组均采用双腔支气管插管静脉全身麻醉,术后行静脉自控镇痛(patient controlled intravenous analgesia,PCIA)。记录术后2,6,12,24,48 h静止和咳嗽视觉疼痛模拟评分(visual analogue scale,VAS)评分;记录术中丙泊酚、瑞芬太尼使用总量;记录术后48 h内镇痛泵按压次数、舒芬太尼使用总量、氟比洛芬酯补救性镇痛例数、镇痛满意度评分;记录术后48 h内镇痛期间不良反应发生情况,包括皮肤瘙痒、恶心呕吐、眩晕等。结果2组术后各时间点静息和咳嗽疼痛VAS评分均呈逐渐升高再降低趋势,且R组升高幅度明显小于G组,组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05),R组术中丙泊酚、瑞芬太尼使用总量明显低于G组(P<0.05),R组术后48 h镇痛按压次数、舒芬太尼使用总量、氟比洛芬酯镇痛例数明显低于G组(P<0.05),镇痛满意度评分明显高于G组(P<0.05)。结论超声引导菱形肌-肋间肌-低位前锯肌平面阻滞联合全身麻醉用于胸腔镜肺大疱切除手术可为患者提供良好术后镇痛,减少围术期镇静镇痛药物应用,提高镇痛满意度。

Objective A total of 70 patients of either gender,aged 18-60 years,with American Society of Anesthesiologists(ASA)gradeⅠorⅡ,were selected for elective thoracoscopic pulmonary bullae resection.Methods They were randomly divided into block combined with general anesthesia group(group R)and simple general anesthesia group(group G),with 35 cases in each group.Group R received rhomboid intercostal and subserratus plane block(RISS)block before anesthesia induction,while group G did not receive intervention.Patients in two groups were given general anesthesia through bronchial intubation and patient-controlled intravenous analgesia(PCIA)after operation.The visual analogue scale(VAS)scores for pain at rest and during coughing at 2,6,12,24 and 48 h after operation were recorded.The total amount of propofol and remifentanil used during the operation were recorded.The times of pressing the analgesia pump,the total amount of sufentanil,the number of cases of flurbiprofen axetil remedial analgesia and the score of analgesia satisfaction were recorded.The incidence of adverse reactions including pruritus,nausea and vomiting,and vertigo were recorded within 48 h after operation.Results The VAS scores for pain at rest and during cough of the two groups were gradually increased and then decreased at each time point after operation,and the increase amplitude of group R was significantly less than that of group G.The differences of interaction between groups,time points and time points between groups were statistically significant(P<0.05).The total amount of propofol and remifentanil used in group R was significantly lower than that in group G(P<0.05).The number of times of pressing,total amount of sufentanil and the number of flurbiprofen axetil analgesia in group R were significantly lower than those in group G(P<0.05),and the score of satisfaction with analgesia was significantly higher than that in group G(P<0.05).Conclusion Ultrasound-guided rhomboid,intercostal and subserratus plane block combined with general anesthesia for thoracoscopic pulmonary bullae resection can provide good postoperative analgesia,reduce the use of perioperative sedative and analgesic drugs,and improve the satisfaction of analgesia.