菱形肌联合前锯肌平面阻滞对肺叶切除患者镇痛效果的影响

Effect of Rhomboid Muscle Combined with Serratus Anterior Plane Block on Analgesia in Patients with Pulmonary Lobectomy

目的探讨菱形肌联合前锯肌平面阻滞(RISS)对肺叶切除手术患者镇痛效果的影响。方法采用前瞻性研究方式,抽样选取2020年10月至2022年8月于我院行胸腔镜肺叶切除术治疗的82例患者作为研究对象,按照随机数字表法及双盲方式分为观察组(n=41)与对照组(n=41),观察组予以RISS阻滞联合静脉镇痛,对照组接受常规静脉镇痛,比较两组患者首次按压自控镇痛泵(PCIA)时间、48 h内PCIA有效按压次数、视觉模拟疼痛评分(VAS)、皮质醇(Cor)、去甲肾上腺素(NE)、CD3^(+)、CD4^(+)、CD8^(+)。结果观察组48 h内PCIA有效按压次数[(6.25±1.78)vs.(7.59±2.45)]次低于对照组,而首次按压PCIA时间[(12.85±2.85)h vs.(10.25±1.78 h)]长于对照组(t=2.274,、2.833、4.955,P<0.05)。重复测量方差分析显示,两组VAS评分、Cor、NE、CD3^(+)、CD4^(+)、CD8^(+)存在时间、组间及时间与组间交互作用,差异有统计学意义(P<0.05);在术后2、6、12、24、72 h时点,观察组的VAS评分均低于对照组(1.15±0.14)vs.(2.45±0.39)分、(2.05±0.31)vs.(3.42±0.59)分、(2.45±0.52)vs.(3.96±0.76)分、(2.11±0.35)vs.(3.02±0.57)分、(1.45±0.19)vs.(2.49±0.37)分(t=20.089、13.162、10.500、8.711、16.010,P<0.05);在术毕、术后24 h、72 h时点,观察组的Cor、NE均低于对照组(P<0.05)。在术后1、2 d,观察组的CD3^(+)、CD4^(+)高于对照组,而CD8^(+)低于对照组(P<0.05)。结论RISS用于胸腔镜肺叶切除术有利于增强镇痛效果,并减轻患者应激反应及减小对免疫功能的影响。

Objective To investigate the effect of rhomboid muscle combined with anterior serration plane block(RISS)on analgesia in patients undergoing pulmonary lobectomy.Methods A prospective study method was used to select 82 patients who underwent thoracoscopic lobectomy in our hospital from October 2020 to August 2022 as research objects,and were divided into observation group(n=41)and control group(n=41)according to random number table method and double-blind method.The observation group was given RISS block combined with intravenous analgesia.The control group received routine intravenous analgesia.The time of first compression of controlled analgesia pump(PCIA),the number of effective PCIA compression within 48 h,visual analogue pain score(VAS),cortisol(Cor),norepinephrine(NE),CD3^(+),CD4^(+),CD8^(+)were compared between the two groups.Results The number of effective PCIA compressions[(6.25±1.78)vs.(7.59±2.45)]in the observation group within 48h was lower than that in the control group,and the time of first PCIA compressions[(12.85±2.85)h vs.(10.25±1.78 h)]was longer than that in the control group(t=2.274,2.833,4.955.,P<0.05).Repeated measurement ANOVA showed that VAS score,Cor,NE,CD3^(+),CD4^(+),CD8^(+)existence time,inter-group and inter-group interaction were statistically significant between the two groups(P<0.05).At 2,6,12,24,72 hours after surgery,The VAS scores of the observation group were lower than those of the control group(1.15±0.14)vs.(2.45±0.39),(2.05±0.31)vs.(3.42±0.59),(2.45±0.52)vs.(3.96±0.76),(2.11±0.35)vs.(3.02±0.57),(1.45±0.19)vs.(2.49±0.37)(t=20.089,13.162,10.500,8.711,16.010,P<0.05);At the end of operation,24 h and 72 h after operation,the Cor and NE of observation group were lower than those of control group(P<0.05).At 1 and 2 days after operation,CD3^(+)and CD4^(+)in observation group were higher than those in control group,while CD8^(+)was lower than those in control group(P<0.05).Conclusion The application of RISS in thoracoscopic lobectomy can enhance the analgesic effect,reduce the stress response of patients and reduce the influence on immune function.