胸腔镜下外科房颤消融术麻醉的优化:SAPB联合全身麻醉的效果

Optimizing anesthesia for thoracoscopic surgical ablation of atrial fibrillation:efficacy of serratus anterior plane block combined with general anesthesia

目的评价前锯肌平面阻滞(SAPB)联合全身麻醉用于胸腔镜下外科房颤消融术的优化效应。方法择期拟行胸腔镜下外科房颤消融术患者80例,性别不限,年龄>18岁,BMI 18~30 kg/m^(2),ASA分级Ⅰ-Ⅲ级,采用随机数字表法将患者分为SAPB联合全身麻醉组(SG组)和全身麻醉组(G组),每组40例。SG组患者术前行超声引导下双侧SAPB(0.375%罗哌卡因各20 ml),G组患者术前不行阻滞,2组均采用全身麻醉。记录患者首次按压镇痛泵时间、术后48 h内有效按压次数和术后48 h内补救镇痛情况。于术前1 d(T_(0))、出恢复室(T_(1))、术后24 h(T_(2))和术后48 h(T_(3))时记录激励式吸气量,记录气管拔管时间。记录术中瑞芬太尼、去甲肾上腺素和麻黄碱使用情况,复苏室停留时间,术后48 h内患者房颤复发、谵妄、呼吸抑制和恶心呕吐的发生情况和术后住院时间。结果与G组相比,SG组首次按压镇痛泵时间延长,术后48 h内有效按压次数减少,补救镇痛率降低,T_(1-3)时激励式吸气量增加,气管拔管时间和术后住院时间缩短,术后48 h内房颤复发率降低(P<0.05)。2组术中瑞芬太尼用量、血管活性药物使用率、术后恶心呕吐、谵妄和呼吸抑制发生率比较差异无统计学意义(P>0.05)。结论SAPB联合全身麻醉可有效改善胸腔镜下外科房颤消融术患者术后镇痛效果,且有利于术后恢复。

Objective:To evaluate the optimization effects of serratus anterior plane block(SAPB)combined with general anesthesia for thoracoscopic surgical ablation of atrial fibrillation(TSAAF).Methods:Eighty American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpatients of either sex,aged>18 yr,with a body mass index of 18-30 kg/m^(2),scheduled for elective TSAAF,were randomly assigned to either SAPB combined with general anesthesia group(SG group)or general anesthesia group(G group),with 40 cases in each group.SG group received ultrasound-guided bilateral SAPB with 0.375%ropivacaine 20 ml each before surgery,while G group did not receive block before operation.Both groups underwent general anesthesia.The time to the first analgesia pump use,the number of successfully delivered doses and requirement for rescue analgesia within 48 h after operation were recorded.Inspiratory spirometry was measured at preoperative day 1(T_(0)),at the time of discharge from the recovery room(T_(1)),and at 24 and 48 h after operation(T_(2,3)).The extubation time was also recorded.The usage of intraoperative remifentanil,norepinephrine and ephedrine,duration of recovery room stay,and occurrence of recurrent atrial fibrillation,delirium,respiratory depression,and nausea/vomiting within 48 h after operation,and length of postoperative hospital stay were recorded.Results:Compared to G group,the time to the first analgesia pump use was significantly prolonged,the number of successfully delivered doses was reduced within 48 h after operation,the rate of rescue analgesia was decreased,inspiratory spirometry was increased at T_(1-3),the extubation time and length of postoperative hospital stay were shortened,and the recurrence rate of atrial fibrillation was decreased within 48 h after surgery in SG group(P<0.05).No significant differences were found between the two groups regarding the intraoperative remifentanil consumption,usage rate of vasoactive drugs,and incidence of postoperative nausea/vomiting,delirium and respiratory depression(P>0.05).Conclusions:Combination of SAPB and general anesthesia can effectively improve the postoperative analgesic effect and is helpful for the recovery in the patients undergoing TSAAF.