超声引导胸横肌平面阻滞在非体外循环冠脉搭桥术中的应用效果

Effect of ultrasound-guided transverse thoracic muscle plane block in patients undergoing off-pump coronary artery bypass grafting

目的探讨超声引导下双侧胸横肌平面阻滞(transverse thoracic muscle plane block,TTPB)在非体外循环下冠脉搭桥手术(off-pump coronary artery bypass grafting,OPCABG)中的应用效果。方法选取2022年1月至2023年9月于青岛市市立医院行OPCABG患者60例,随机分为TTPB组(B组)和全麻组(G组)各30例。比较两组麻醉诱导前(T1)、开胸骨后(T2)、血管吻合完毕(T3)和术毕(T4)的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP);比较术中窦缓、窦速、低血压、高血压发生率,术中舒芬太尼、瑞芬太尼用量;同时比较T1、T2和T4时周围血的血浆血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)和去甲肾上腺素(norepinephrine,NE)水平;以及疼痛视觉模拟评分(visual analog scale,VAS),镇痛泵有效按压次数及气管插管保留时间、重症加强护理病房(intensive care unit,ICU)停留时间,以及恶心呕吐和术后谵妄发生率。结果最后共纳入56例患者,T组27例,G组29例。两组各时间点的MAP、HR水平均无统计学差异(P>0.05),但B组高血压发生率更低(P<0.05)。T1、T2、T4时,两组AngⅡ、NE呈上升趋势,且T2、T4时,B组AngⅡ、NE明显低于G组(P<0.05)。与G组相比,B组术中阿片类药物用量、术后镇痛泵使用次数明显减少(P<0.05),术后12 h、24 h静息运动VAS较低(P<0.05),气管插管保留时间、ICU停留时间缩短(P<0.05),恶心呕吐和术后谵妄发生率较低(P<0.05)。结论超声引导下双侧TTPB阻滞用于OPCABG手术患者,能够有效降低机体血液应激指标,稳定血流动力学水平,提高术后镇痛效果,减少阿片类药物用量,有利于患者术后恢复。

Objective To investigate the application effect of ultrasound-guided transverse thoracic muscle plane block(TTPB)combined with general anesthesia in off-pump coronary artery bypass grafting(OPCABG).Methods A total of 60 patients underwent OPCABG in Qingdao Municipal Hospital from January 2022 to September 2023 were randomly divided into 30 cases of general anesthesia(group G)and 30 cases of general anesthesia combined with TTPB(group B).Heart rate(HR),mean arterial pressure(MAP)was recorded and compared before anesthesia induction(T1),after thoracicotomy(T2),after vascular anastomosis(T3)and after surgery(T4).Venous blood was collected at T1,T2 and T4 to measure plasma angiotensin(AngⅡ)and norepinephrine(NE)levels.Intraoperative sinus brady,sinus velocity,hypotension,hypertension,intraoperative sufentanil and remifentanil dosage were also recorded.After operation,the analgesic visual analogue scale(VAS),the number of effective compressions of the analgesic pump,retention time of endotracheal intubation,the length of ICU stay,the incidence of nausea,vomiting and postoperative delirium were compared between two groups.Results Finally,56 patients were included in this study,with 27 in group B and 29 in group G.There was no significant difference in MAP and HR levels between the two groups at each time point(P>0.05),but the incidence of hypertension in group B was lower than that in group G(P<0.05).The concentration of AngⅡand NE at T1,T2 and T4 in the two groups showed an upward trend.At T2 and T4,the AngⅡand NE levels in group B were significantly lower than that in group G(P<0.05).Compared with group G,group B had significantly lower intraoperative opioid dosage and postoperative analgesic pump use(P<0.05),lower VAS at 12h and 24h after surgery(P<0.05),shorter retention time for endotracheal intubation and ICU stay(P<0.05),and lower incidences of nausea,vomiting and postoperative delirium(P<0.05).Conclusion Ultrasound-guided bilateral TTPB block in patients undergoing OPCABG surgery can effectively reduce the patients'blood stress indicators,stabilize the hemodynamic level,improve the postoperative analgesic effect,reduce the dosage of opioids,and facilitate the postoperative recovery of patients.