国际麻醉学与复苏杂志   2019, Issue (9): 0-0
    
单次竖脊肌平面阻滞联合患者自控静脉镇痛用于食管癌根治术术后镇痛的研究
王强, 郑晖, 张国华1()
1.国家癌症中心/中国医学科学院北京协和医学院肿瘤医院
Effects of combined ultrasound-guided erector spinae plane block and patient controlled intravenous analgesia on postoperative pain in patients undergoing radical resection of esophageal carcinoma
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摘要：

目的　探索单次竖脊肌平面阻滞（erector spinae plane block, ESPB）联合患者自控静脉镇痛（patient controlled intravenous analgesia, PCIA）用于食管癌根治术术后镇痛的效果及其对患者满意度的影响。　方法　择期行食管癌根治术的患者40例，男20例，女20例，ASA分级Ⅰ、Ⅱ级。采用随机数字表法将患者分为ESPB联合PCIA组（EP组）组和单纯PCIA组（IA组），每组20例。EP组全身麻醉诱导前行ESPB，20 min后测定阻滞范围，术毕两组均采用PCIA。记录术后1、6、12、24、48 h时静息和咳嗽VAS评分，镇痛泵按压次数，药液输注总量，术后不良反应发生情况及患者满意度。　结果　ESPB 20 min后可阻滞T3~T9脊神经支配区域。EP组术后各时点静息和咳嗽VAS评分低于IA组（P＜0.05），镇痛泵按压次数及药液输注总量少于IA组（P＜0.05），术后恶心呕吐（postoperative nausea and vomiting, PONV）发生率低于IA组（P＜0.05），患者满意度高于IA组（P＜0.05）。　结论　单次ESPB联合PCIA用于食管癌根治术术后镇痛较单纯PCIA更为有效，不良反应少，患者总体满意度高。
关键词： 竖脊肌平面阻滞；　患者自控静脉镇痛；　食管癌根治术；　镇痛效果；　满意度
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To observe the effects of one time erector spinae plane block (ESPB) combined with patient controlled intravenous analgesia(PCIA) on postoperative pain and satisfactory extent of patients undergoing radical resection of esophageal carcinoma by thoracotomy operation. 　Methods　 Forty patients[20 males and 20 females, American Society of Anesthesiologists(ASA) status Ⅰ or Ⅱ], scheduled for radical resection of esophageal carcinoma by open chest surgery, were randomly assigned into two groups: ESPB combined with PCIA group(group EP) and PCIA only group (group IA). ESPB was performed in group EP before anesthesia induction. The effect was evaluated by detecting the area of block after 20 min. The patients in both group used PCIA after surgery. Visual Analogue Scale (VAS) scores were recorded at 1, 6, 12, 24 h and 48 h after operation both in the resting and the coughing state. The times of pressing analgesic pump, the total volume of analgesic drugs infused by analgesic pump, the frequency and extent of adverse reaction and satisfactory extent of patients were recorded as well.　Results　Twenty min after EPSB, pain sense of patients in group EP was successfully blocked in the skin area innervated by spinal nerve between T3 to T9。The VAS scores both at rest and during coughing in group EP were lower than those in group IA(P＜0.05). The times of pressing analgesic pump and the volume of infused analgesic drugs were significantly less in group EP than the times and volume in group IA (P＜0.05). Meanwhile, the frequencies of nausea and vomiting in group EP were significantly lower than those in group IA (P＜0.05). Also, the degree of satisfaction in group EP was significantly higher than the degree in group IA(P＜0.05).　Conclusions　For radical resection of esophageal carcinoma by thoracotomy, ESPB combined with PCIA is a more effective method for postoperative analgesia than PCIA only. Also, the gross satisfactory extent is significantly higher in group EP than that in group IA. Less adverse effects were observed in patients of group EP.
Key words: Erector spinae plane block;　Patient controlled intravenous analgesia;　Radical resection of esophageal carcinoma;　Analgesic effect;　Degree of satisfaction