前锯肌平面与胸椎旁神经阻滞治疗创伤性多发肋骨骨折的临床研究

Clinical Research on Serratus Anterior Plane Block and Thoracic Paravertebral Block in the Treatment of Traumatic Multiple Rib Fractures

目的:研究超声引导下胸椎旁神经阻滞(TPVB)和前锯肌平面阻滞(SAPB)对创伤性多发肋骨骨折患者胸壁镇痛的临床疗效。方法:选取2020年10月—2021年10月宜昌市中心人民医院收治的创伤性多发肋骨骨折患者60例,随机分为SAPB组和TPVB组,每组各30例。统计患者的基本情况及损伤特征,比较两组患者阻滞前和阻滞后1 h、6 h、12 h的胸壁疼痛视觉模拟量表(VAS)评分、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))。结果:SAPB和TPVB两组阻滞后1 h、6 h、12 h的VAS评分、PaCO_(2)均较阻滞前减低,PaO2均较阻滞前升高,差异均有统计学意义(均P<0.05)。SAPB和TPVB两组组间比较,阻滞前、阻滞后1 h、6 h、12 h的VAS评分、PaCO_(2)、PaO_(2)均无明显差异(均P>0.05)。结论:SAPB和TPVB两种阻滞技术对创伤性多发肋骨骨折均有良好的胸壁镇痛及呼吸功能改善作用。

Objective:To analyze the effect of ultrasound-guided serratus anterior plane block(SAPB)and thoracic paravertebral block(TPVB)on analgesia in patients with traumatic multiple rib fractures.Methods:Totally 60 cases of traumatic multiple rib fractures admitted to Yichang Central People's Hospital from October 2020 to October 2021 were included in this study.Among them,60 patients were divided into the SAPB group(n=30)and the TPVB group(n=30)using random number table method.The patient's basic condition and injury characteristics were recorded.Chest wall pain visual analogue scale(VAS)score,arterial partial pressure of oxygen(PaO2),and arterial partial pressure of carbon dioxide(PaCO2)were recorded and compared in patients before block(T0),1 hour after block(T1),6 hour after block(T6)and 12 hours after block(T12).Results:In both SAPB and TPVB groups,VAS scores at 1 h,6 h,and 12 h after the blockade were lower than those before the blockade(all P<0.05).PaCO2 was decreased,while PaO2 was increased at 1 h,6 h and 12 h after blockade compared with that before blockade(all P<0.05).There were no significant differences in the VAS score、PaO2 and PaCO2 before the blockade,1 h,6 h,and 12 h after the blockade between these two groups(all P>0.05).Conclusion:Both SAPB and TPVB techniques have good effects on chest wall analgesic and improvement of respiratory function for traumatic multiple rib fractures.