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摘要：
目的 探讨超声引导下双侧竖脊肌平面阻滞（erector spinae plane block, ESPB）在儿童漏斗胸Nuss手术的应用和对术后镇痛的影响。 方法 行择期漏斗胸Nuss手术的患儿60例，年龄6~12岁，ASA分级Ⅰ、Ⅱ级，按随机数字表法分为竖脊肌平面阻滞组（E组）和对照组（C组），每组30例。两组患儿均采用相同的麻醉诱导及维持方案，E组于麻醉诱导后手术开始前30 min行双侧T5水平的ESPB，C组注射等量生理盐水。记录两组患儿诱导前（T1）、手术开始后0.5 h（T2）和术后2 h（T3）时的血皮质醇水平，术后2、4、6、12、24、48 h的疼痛相关行为学评分法（Face, Legs, Activity, Cry, and Consolability, FLACC）评分，PACU复苏情况（机械通气时间、拔管时间、PACU停留时间），术中用药（丙泊酚和瑞芬太尼）情况，术后镇痛情况［患者自控镇痛（patient‑controlled analgesia, PCA）泵按压次数、补救镇痛例数］及不良反应（恶心呕吐、呼吸抑制）发生情况。 结果 两组T2、T3时血皮质醇水平较T1升高（P<0.05），E组T3时血皮质醇水平低于C组（P<0.05）。E组术后2、4、6、12 h FLACC评分低于C组（P<0.05）。E组术中丙泊酚用量、术中瑞芬太尼用量、机械通气时间、拔管时间、PACU停留时间、PCA泵按压次数和补救镇痛例数低于C组（P<0.05）。其余指标两组间差异无统计学意义（P>0.05）。 结论 超声引导下ESPB用于儿童漏斗胸Nuss手术能有效抑制术后应激反应，提供良好的术后镇痛，缩短PACU停留时间。
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Abstract: Objective To explore the application of bilateral erector spinae plane block (ESPB) guided by ultrasound in children's Nuss operation for pectus excavatum and its effects on postoperative analgesia. Methods A total of 60 children, aged 6‒12 years, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ, who were scheduled for Nuss operation were enrolled. According to the random number table method, they were divided into two groups (n=30): an ESPB group (group E) and a control group (group C). Both groups underwent the same regimens of anesthesia induction and maintenance. Bilateral ESPB was performed in group E at T5 after anesthesia induction and 30 min before operation, while group C was injected with the same volume of normal saline. The levels of blood cortisol were recorded before induction (T1), 0.5 h after operation (T2) and 2 h after operation (T3). The Face, Legs, Activity, Cry, and Consolability (FLACC) pain score, postanesthesia care unit (PACU) recovery (mechanical ventilation time, extubation time, and the length of PACU stay), and the consumption of medication (propofol and remifentanil) during surgery were recorded. Postoperative analgesia, e.g. the time of pressing patient‑controlled analgesia (PCA) pump, and the number of rescue analgesia cases, and adverse reactions (nausea, vomiting and respiratory depression) were observed. Results The levels of blood cortisol at T2 and T3 were higher than those at T1 in both groups (P<0.05). The level of blood cortisol at T3 in group E was lower than that in group C (P<0.05). Compared with group C, group E presented decreased FLACC score 2, 4, 6, and 12 h after operation (P<0.05). The consumption of propofol and remifentanil, ventilation time, extubation time, the length of PACU stay, the time of pressing patient‑controlled analgesia (PCA) pump and the number of rescue analgesia cases in group E were lower than those in group C (P<0.05). There was no statistical difference in other indicators between the two groups (P>0.05). Conclusions Application of ultrasound‑guided ESPB in children undergoing Nuss operation for pectus excavatum can effectively inhibit postoperative stress, provide good postoperative analgesia and shorten the length of PACU stay.
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