超声引导下前锯平面肌神经阻滞联合肋间神经阻滞在胸腔镜下肺切除术后镇痛的效果研究

Effect of ultrasound-guided serratus anterior muscle nerve block combined with intercostal nerve block in analgesia after thoracoscopic pneumonectomy

目的探讨超声引导下前锯平面肌神经阻滞联合肋间神经阻滞在胸腔镜下肺切除术后镇痛的效果。方法选择该院2020年1月—2021年6月择期需要进行胸腔镜下肺切除术的70例患者作为研究对象,按照随机数字表法将患者分为对照组(n=35,切口局部浸润镇痛)和观察组(n=35,超声引导下前锯平面肌神经阻滞联合肋间神经阻滞镇痛)。选取麻醉苏醒后2、12、24、48h的VAS疼痛评分、患者术前、术后1d、2d的C反应蛋白(CRP)、降钙素原(PCT)、CD3^(+)、CD4^(+)、CD8^(+)以及CD4^(+)/CD8^(+)水平、术后48h补救性镇痛情况、患者的康复情况以及住院期间不良反应的发生率、镇痛效果进行评价。结果观察组患者的2h、12h、24h、48h的安静和咳嗽VAS评分明显低于对照组(P<0.05);术后1d、2d的PCT、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较对照组低,而观察组CD8^(+)较对照组高(P<0.05);观察组的患者静脉自控镇痛药物用量为(106.98±6.21)ml,显著低于对照组的(118.56±7.92)ml,观察组的补救镇痛次数为6(17.14%),明显低于对照组(14,40.00%),差异均有统计学意义(P<0.05)。观察组患者术后的首次下床活动时间以及首次进食固体食物的时间明显短于对照组,术后48h内下床活动总次数多于对照组的总次数(P<0.05),观察组患者恶心呕吐发生率明显低于对照组,差异有统计学意义(P<0.05)。结论超声引导下前锯肌平面阻滞联合肋间神经阻滞在胸腔镜下肺切除术后镇痛比传统切口局部浸润提供的术后镇痛时间更持久,且能有效减少镇痛药物的补救次数和剂量,镇痛效果明显,对免疫功能影响更小,在促进患者康复以及减少患者恶心呕吐的不良反应发生上更优,值得临床推广。

Objective Explore the analgesic effect of ultrasound guided anterior serrated plane muscle nerve block combined with intercostal nerve block after thoracoscopic pulmonary resection.Methods We selected seventy patients who were scheduled to undergo thoracoscopic pneumonectomy in Cangzhou People's Hospital from January 2020 to June 2021 as the research subjects.According to random number table method,patients who met the inclusion criteria were divided into control group(n=35,incisional local infiltration analgesia)and observation group(n=35,ultrasound-guided paravertebral plane muscle nerve block combined with intercostal nerve block analgesia).Evaluate analgesic effect of two groups by selecting VAS pain score at 2,12,24,and 48 hours after anesthesia awakening,C-reactive protein(CRP),procalcitonin(PCT),levels of CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)before surgery and 1 and 2 days after surgery,as well as the recovery and incidence of adverse reactions during hospitalization.Results VAS scores of quiet and cough in observation group at 2,12,24,and 48 hours were significantly lower than those in control group(P<0.05).The levels of PCT,CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in observation group were lower than those in control group on the 1st and 2nd day after surgery,while CD8^(+)in observation group was higher than those in control group(P<0.05).The dosage of patient-controlled intravenous analgesia drugs in observation group was(106.98±6.21)ml,significantly lower than control group's(118.56±7.92)ml,and the number of rescue analgesia times in observation group was 6(17.14%),significantly lower than control group's 14(40.00%).The differences were statistically significant(P<0.05).The first time of getting out of bed and eating solid food for observation group patients after surgery was significantly shorter than that of control group.The total number of times of getting out of bed activities within 48 hours after surgery was greater than that of control group(P<0.05).The incidence of nausea and vomiting in observation group patients was significantly lower than that of control group,and the difference was statistically significant(P<0.05).Conclusion Ultrasound guided anterior serratus muscle plane block combined with intercostal nerve block provides longer postoperative pain relief time after thoracoscopic lung resection compared to traditional incision local infiltration,and can effectively reduce the number and dosage of analgesic drugs.The analgesic effect is significant,and the impact on immune function is smaller.It is more effective in promoting patient recovery and reducing adverse reactions such as nausea and vomiting,and is worthy of clinical promotion.