超声引导下3种阻滞技术对行电视辅助胸腔镜手术患者早期恢复影响比较

Comparison of the effects of three blocking techniques under ultrasound guidance on early recovery of patients undergoing video-assisted thoracoscopic surgery

目的探讨超声引导下竖脊肌平面阻滞(ESPB)、前锯肌平面阻滞(SAPB)、胸椎旁神经阻滞(TPVB)3种阻滞法对行电视辅助胸腔镜手术(VATS)患者术后早期恢复的影响。方法选取年龄18~65岁、美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,2020年7月至2021年12月于该院择期行VATS的患者90例,随机分为3组,分别行ESPB(E组)、SAPB(S组)和TPVB(T组),每组30例。观察比较3组患者术中阿片类药物、血管活性药物使用情况,术后第1天术后恢复质量(QoR-40)评分,以及术后2、4、8、12、24 h疼痛[视觉模拟评分法(VAS)]评分,镇痛泵首次按压时间,曲马朵镇痛补救率,患者满意度,神经阻滞穿刺时间,穿刺并发症发生情况,术中低血压发生率,首次下床活动时间,术后住院时间等。结果3组患者术中舒芬太尼用量相近,术后第1天的QoR-40评分及术后2、4、12、24 h静息和咳嗽时疼痛VAS评分、患者满意度比较,差异均无统计学意义(P>0.05)。E、S组患者术中血管活性药物使用率较T组明显降低,E、S组患者神经阻滞穿刺时间明显短于T组,而T组患者低血压发生率显著高于E、S组,差异均有统计学意义(P<0.05)。3组患者术后镇痛泵首次按压时间、有效按压次数、曲马朵镇痛补救率、首次下床活动时间、术后住院时间比较,差异均无统计学意义(P>0.05)。3组患者穿刺均无气胸、误注入血管、血肿等并发症发生。结论超声引导下ESPB和SAPB均能加快VATS患者术后康复和提供有效镇痛,且超声引导下ESPB和SAPB较TPVB操作更简单快捷,术中低血压发生率更低。

Objective To investigate the effects of erector spinal plane block(ESPB),serratus anterior plane block(SAPB) and thoracic paravertebral nerve block(TPVB) under ultrasound guidance on the early postoperative recovery of patients undergoing video-assisted thoracoscopic surgery(VATS).Methods A total of 90 patients aged 18-65 years old, American Association of Anesthesiologists(ASA) Grade Ⅰ-Ⅱ,who underwent elective VATS in the Affiliated Hospital of Guizhou Medical University from July 2020 to December 2021 were selected, and they were randomly assigned into three groups: ESPB(group E),SAPB(group S) and TPVB(group T),with 30 cases in each group.The use of opioid and vasoactive drugs during the operation, the QoR-40 score on the first day after operation, and the pain score [visual mode Quasi-scoring method(VAS)] at 2,4,8,12 and 24 hours after operation, first pressing time of analgesic pump, analgesic recovery rate of Tramadol, patient satisfaction, puncture time of nerve block, occurrence puncture complications, the incidence of intraoperative hypotension during operation, the time of getting out of bed for the first time, and the postoperative hospitalization time in the three groups were observed and compared.Results The dosage of sufentanil in the three groups was similar.There was no significant difference in QoR-40 score on the first day after operation, VAS score at rest and cough at 2,4,12,24 h after operation, and patient satisfaction(P>0.05).The utilization rate of vasoactive substances in E and S groups was significantly lower than that in T group, and the puncture time of nerve block in E and S groups was significantly shorter than that in T group, while the incidence of hypotension in T group was significantly higher than that in E and S groups, and the differences were statistically significant(P<0.05).There was no significant difference in the first compression time, effective compression times, analgesic recovery rate of Tramadol, first ambulation time and postoperative hospitalization time among the three groups(P>0.05).There were no complications such as pneumothorax, accidental injection into blood vessels and hematoma in all three groups.Conclusion Both ESPB and SAPB under ultrasound guidance all can accelerate the postoperative rehabilitation of VATS patients and provide effective analgesia, and the operation of ESPB and SAPB under ultrasound guidance is simpler and faster than TPVB,and the incidence of intraoperative hypotension during operation is lower.