竖脊肌平面阻滞对非体外循环冠状动脉旁路移植术中阿片类药物用量的影响

The effect of erector spinae plane block on opioid dosage during off-pump coronary artery bypass grafting surgery

目的探讨双侧竖脊肌平面阻滞(ESPB)对正中开胸非体外循环冠状动脉旁路移植术(CABG)患者术中阿片类药物用量的影响。方法选取2023年1月至11月在济宁市第一人民医院心脏外科因冠状动脉粥样硬化性心脏病接受正中开胸非体外循环CABG的成人患者38例。采用计算机随机数字生成器分成两组:ESPB组和对照组。麻醉诱导前,ESPB组在超声引导下将0.375%罗哌卡因20 ml注射至T5横突与竖脊肌之间,对侧行同样的阻滞。对照组给予同等剂量的生理盐水进行双侧阻滞。比较两组术中舒芬太尼的用量,与阿片类药物相关的事件(机械通气时间、心脏重症监护室停留时间、住院时间、恶心呕吐)以及与神经阻滞相关的不良反应(气胸、局麻药中毒、穿刺部位感染)。结果对照组1例患者术中紧急体外循环被排除在外,最终ESPB组纳入19例患者,对照组纳入18例患者。ESPB组术中舒芬太尼的用量为150.0(120.0,160.0)μg,对照组的用量为200.0(166.3,221.3)μg,两组比较差异有统计学意义(Z=-2.88,P=0.004)。ESPB组机械通气时间为438.5(354.3,521.5)min,对照组为486.5(447.5,664.5)min,两组比较差异有统计学意义(Z=-2.34,P=0.019)。两组患者在心脏重症监护室停留时间[65.4(45.4,86.5)min,68.2(49.9,88.5)min]、住院时间[13.5(11.0,15.3)d,12.5(10.0,15.0)d]比较,均差异无统计学意义(Z=-0.46,1.09;均P>0.05)。两组中分别有2例患者术后出现恶心呕吐,差异无统计学意义(P>0.05)。两组患者均未发生与神经阻滞相关的并发症。结论术前ESPB可显著降低非体外循环CABG患者术中阿片类药物的用量,缩短术后机械通气时间,且不增加副作用。

Objective Observing the effect of bilateral erector spinae plane block(ESPB)on the intraoperative opioid dosage in patients undergoing off-pump coronary artery bypass grafting(CABG)with midline thoracotomy.Methods From January to November 2023,38 adult patients with coronary atherosclerotic heart disease were selected from the Cardiac Surgery Department of Jining No.1 People′s Hospital.They underwent a median sternotomy and off-pump CABG.The computer random number generator was used to divide them into 2 groups:the ESPB group and the control group.Before anesthesia induction,20 ml of 0.375%ropivacaine was injected under ultrasound guidance between the T5 transverse process and the erector spinae muscle in the ESPB group,and the same blockade was performed on the opposite side.The same dose of physiological saline was given in the control group for bilateral block.The dosage of sufentanil used during surgery,events related to opioids(mechanical ventilation time,cardiac intensive care unit time,hospital stay,postoperative nausea and vomiting),and adverse reactions related to nerve block(pneumothorax,local anesthetic toxicity,infection at the puncture site)were recorded.Results One patient was excluded from the control group since the emergency extracorporeal circulation during surgery.Finally,19 patients were included in the ESPB group,while 18 patients were included in the control group.The dosage of sufentanil during surgery was 150.0(120,160)μg in the ESPB group,while in the control group was 200.0(166.3,221.3)μg.There was a statistical difference(Z=-2.88,P=0.004)between the 2 groups.The average mechanical ventilation time in the ESPB group was 438.5(354.3,521.5)min,while in the control group was 486.5(447.5,664.5)min.There was a statistical difference between the 2 groups(Z=-2.34,P=0.019).There were no significant differences in the length of stay in the cardiac intensive care unit[65.4(45.4,86.5)min,68.2(49.9,88.5)min]and the length of hospital stay[13.5(11.0,15.3)d,12.5(10.0,15.0)d]between the 2 groups(Z=-0.46,1.09,P>0.05).There were 2 patients in each group who experienced postoperative nausea and vomiting,and the difference was not statistically significant(P>0.05).None of the patients in either group developed complications associated with nerve blocks.Conclusions Preoperative ESPB significantly reduce the intraoperative opioid dosage in patients undergoing off-pump CABG,shorten mechanical ventilation time,and do not increase side effects.ESPB is a safe and effective anesthesia management technique for CABG.