超声引导下前锯肌阻滞在单侧多发肋骨骨折患者术后恢复中的应用

Application of ultrasound-guided serratus anterior plane block in postoperative recovery of patients with unilateral multiple rib fractures

目的观察超声引导前锯肌阻滞(SAPB)对于单侧多发肋骨骨折患者术后疼痛评分及呼吸功能恢复的影响。方法选取北京丰台右安门医院外科2019年5月至2021年5月拟行单侧多发肋骨骨折内固定手术的患者76例,随机分为全身麻醉组(GA组,n=38)和全身麻醉联合前锯肌阻滞组(GA+SAPB组,n=38)。两组均接受全身麻醉,GA+SAPB组全身麻醉诱导后以0.5%罗哌卡因行患侧超声引导前锯肌阻滞。所有患者在手术结束后接受舒芬太尼的静脉镇痛泵,于手术结束后2、6、12、24和48 h对患者进行安静状态和咳嗽时疼痛程度评分,记录术后12、24 h动脉血氧分压、二氧化碳分压。记录48 h止痛泵有效按压次数及需要使用镇痛药补救例数。同时观察术后有无局部血肿、恶心、呕吐、呼吸抑制等不良反应的发生。结果GA+SAPB组术后12 h氧分压明显高于GA组,二氧化碳分压明显低于GA组,差异有统计学意义(P<0.05);GA组术后2、6、12 h平静状态及咳嗽时的VAS评分均高于GA+SAPB组,差异有统计学意义(P<0.05);两组患者术后24、48 h的VAS评分比较,差异无统计学意义(P>0.05);GA组镇痛泵有效按压次数明显多于GA+SAPB组,使用氟比洛芬酯补救率明显高于GA+SAPB组,差异有统计学意义(P<0.05)。GA组术后恶心、呕吐发生率为13.16%,GA+SAPB组术后呕吐率为0%,差异有统计学意义(P<0.05)。两组患者术后均未出现血氧饱和度降低、呼吸次数减少等呼吸抑制的表现,均未发现穿刺部位血肿、气胸等不良反应。结论超声引导前锯肌阻滞能提高患者术后氧分压,降低二氧化碳分压,降低术后VAS评分,减少术后镇痛药物用量。

Objective To observe the effect of ultrasound-guided serratus anterior plane block(SAPB)on postoperative pain score and respiratory function recovery of patients with unilateral multiple rib fractures.Methods A total of 76 patients who planned to undergo internal fixation for unilateral multiple rib fractures in the Department of Surgery of Beijing Fengtai Youanmen Hospital from May 2019 to May 2021 were randomly divided into the general anesthesia group(GA group,n=38)and the general anesthesia combined with serratus anterior plane block group(GA+SAPB group,n=38).Both groups received general anesthesia.In GA+SAPB group,ultrasound-guided SAPB was performed on the affected rib with 0.5%ropivacaine after induction of general anesthesia.All patients were given analgesia pump with intravenous sufentanil at the end of the operation.The patients were scored for pain in quiet state and pain when coughing at 2,6,12,24 and 48 hours after the operation,and the arterial oxygen partial pressure and carbon dioxide partial pressure at 12 and 24 hours after the operation were recorded.The effective pressing times of analgesic pump in 48 hours and the number of patients who need to use analgesics as remedial drugs were recorded.At the same time,the occurrence of local hematoma,nausea,vomiting,respiratory depression and other adverse reactions were observed.Results The arterial oxygen partial pressure at 12 hours in GA+SAPB group was significantly higher than that in GA group,and the carbon dioxide partial pressure was significantly lower than that in GA group,with statistically significant differences(P<0.05).The visual analog scale(VAS)scores in quiet state and when coughing in GA group at 2,6 and 12 hours after operation were significantly higher than those in GA+SAPB group,with statistically significant differences(P<0.05).There was no statistically significant difference in VAS score between the two groups at 24 and 48 hours after operation(P>0.05).The effective pressing times of analgesic pump in GA group was significantly higher than that in GA+SAPB group,and the rescue rate of flurbiprofen axetil was significantly higher than that in the GA+SAPB group,with statistically significant differences(P<0.05).The incidence of postoperative nausea and vomiting was 13.16%in GA group and the incidence of vomiting was 0%in GA+SAPB group,with statistically significant differences(P<0.05).There was no respiratory depression suggested by decreased blood oxygen saturation and respiratory times,and no adverse reactions such as hematoma and pneumothorax at the puncture site were found in both groups.Conclusion Ultrasound-guided SAPB can improve postoperative oxygen partial pressure,reduce carbon dioxide partial pressure,and lower postoperative VAS score and the dosage of postoperative analgesic drugs.