国际麻醉学与复苏杂志   2019, Issue (3): 0-0
    
竖脊肌平面阻滞对肋骨肿瘤切除患者镇痛效果的影响
于双, 赵尧平, 杨占民1()
1.航天中心医院
Effects of ultrasound-guided erector spinae plane block for pain relief in patients after rib tumor resection
 全文:
摘要:

目的 探讨竖脊肌平面阻滞(erector spinae plane block, ESPB)对肋骨肿瘤切除患者术中及术后镇痛效果的影响。 方法 择期行肋骨肿瘤切除术的患者40例,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为全身麻醉复合ESPB组(E组)和单纯全身麻醉组(G组),每组20例。E组患者全身麻醉前超声引导下实施ESPB,在肋骨肿瘤所在节段给予0.5%罗哌卡因20 ml,两组患者全身麻醉方法相同,术后均使用患者自控静脉镇痛(patient controlled intravenous analgesia, PCIA)。记录E组患者阻滞20 min后腋中线处感觉阻滞节段,记录两组患者入室后、诱导后、切皮时、手术开始后30 min、术毕即刻的MAP和心率,术中瑞芬太尼用量,患者术后1、4、12、24、36 h时静息和活动VAS评分,平均住院时间及患者满意度。 结果 E组患者ESPB 20 min后感觉阻滞节段为(5.2±0.9)个,E组患者术中瑞芬太尼用量及切皮时、术毕即刻的MAP、心率均低于G组(P<0.05),术后1、4、12、24、36 h E组患者静息VAS评分、活动VAS评分和平均住院时间低于G组(P<0.05),E组患者满意度高于G组(P<0.05)。 结论 ESPB应用于肋骨肿瘤切除术患者安全、有效,能够提供良好的术中及术后镇痛,患者满意度高。

关键词: 竖脊肌平面阻滞; 超声监测; 肋骨; 骨肿瘤; 术后镇痛
Abstract:

Objective To explore the effects of ultrasound-guided erector spinae plane block(ESPB) for pain relief in patient after rib tumor resection. Methods A total of 40 patients (American Society of AnesthesiologistsⅠ-Ⅱ) undergoing rib tumor resection were randomly divided into two groups. Patients in group G received general anesthesia alone. Meanwhile, those in group E underwent ultrasound-guided ESPB combined under general anesthesia, and 20 ml of 0.5% ropivacaine was administered at the ESPB where rib tumor was located. Both groups received patient controlled intravenous analgesia (PCIA). The segments of sensory block on mid-axillary line were recorded 20 min after ESPB. The doses of remifentanil, mean arterial pressure (MAP), heart rate were recorded before entry into the operation room, after anesthesia induction, when the skin was excised, 30 min after surgery began and at the end of surgery. The rest and active visual analogue scale (VAS) at 1, 4, 12, 24 h and 36 h after operation, average hospitalization stay and patient satisfaction were recorded. Results Patients in group E reported 5.2±0.9 sensory block 20 min after ESPB. Compared with group G, group E used a less dose of remifentanil during operation, and demonstrated decreased MAP and heart rate when the skin was excised and at the end of surgery (P<0.05). Compared with group G, group E presented lower the rest and active VAS at 1, 4, 12, 24 h and 36h after operation and average hospitalization stay (P<0.05). Compared with group G, group E presented better patient satisfaction (P<0.05). Conclusions ESPB is safe and effective for patient after excision of rib tumor, with good patient satisfaction.

Key words: Erector spinae plane block; Ultrasonic monitoring; Ribs; Bone neoplasms; Postoperative analgesia