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不同时间点B超引导竖脊肌平面阻滞对胸腔镜下肺叶切除术后早期疼痛的影响

Effect of ultrasound-guided erector spinae plane block on early pain after thoracoscopic lobectomy
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摘要 目的探讨不同时间点B超引导竖脊肌平面阻滞对胸腔镜下肺叶切除患者术后早期疼痛和应激的影响。方法选取浙江省温州市人民医院2018年6—12月行胸腔镜下肺叶切除术患者60例,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,将患者按随机数字表法分为联合1组、联合2组和对照组,每组20例。对照组患者术后仅接受患者自控静脉镇痛(PCIA),联合1组和联合2组患者分别在切皮前和术毕行B超引导单侧竖脊肌平面阻滞并联合PCIA。记录麻醉诱导前、插管后即刻、切皮、胸腔镜套管置入、手术30min、胸腔镜套管撤出及拔管即刻平均动脉压(MAP)、心率、手术体积描记指数(SPI)、状态熵(SE)和反应熵(RE);拔管后即刻及拔管后1、6、12、24和48h评估静息和咳嗽时疼痛视觉模拟评分(VAS);拔管后48h镇痛泵按压次数、舒芬太尼补救次数和不良反应发生率。手术结束即刻及拔管后24h采静脉血测定去甲肾上腺素(NE)、肾上腺素(E)和皮质醇。结果60例患者均完成研究。三组术中输液量、手术时间、MAP、心率、SPI、RE、SE、不良反应(恶心呕吐、尿潴留、瘙痒)发生率及舒芬太尼补救次数比较差异无统计学意义(P>0.05)。与对照组比较,联合1组和联合2组拔管后即刻至拔管后48h静息VAS和拔管后即刻至拔管后24h咳嗽VAS明显低于对照组,差异有统计学意义(P<0.05)。联合1组和联合2组拔管后1~24h镇痛泵按压次数明显少于对照组[1(0,1)和1(0,1)次比3(2,4)次、2(1,3)和1(0,2)次比5(2,7)次、3(1,4)和3(2,5)次比6(3,7)次、1(0,1)和2(1,3)次比4(2,6)次、4(2,5)和4(2,5)次比6(3,8)次],差异有统计学意义(P<0.05)。手术结束即刻,联合1组NE、E和皮质醇明显低于对照组和联合2组[(32.7±7.3)ng/L比(88.7±11.3)和(80.5±13.4)ng/L、(44.5±9.9)ng/L比(59.3±10.2)和(55.6±11.6)ng/L、(4.0±2.6)mg/L比(25.4±6.8)和(18.9±5.3)mg/L],差异有统计学意义(P<0.05),对照组与联合2组比较差异无统计� Objective To investigate the effect of ultrasound-guided erector spinae plane (ESP) block on early postoperative pain and stress response in patients undergoing thoracoscopic lobectomy. Methods Sixty American Society of Anesthesiologists status Ⅰ or Ⅱ grade patients who had underwent thoracoscopic lobectomy from June to December 2018 in Wenzhou People′s Hospital were selected. The patients were divided into combined group 1, combined group 2 and control group according to the random digits table method with 20 cases each. The patients in control group only received patient controlled intravenous anesthesia (PCIA) after surgery. While in combined group 1 and 2, unilateral ESP block was performed before skin cutoff or after surgery under the guidance of ultrasonography, respectively, to replenish PCIA administration. The mean arterial pressure (MAP), heart rate, plethysmography index (SPI), state entropy (SE) and reaction entropy (RE) before anesthesia induction, immediately after intubation, at the time of incision, and thoracoscopic cannulation, 30 min after surgery, and at the time of thoracoscopic cannula withdrawal were recorded. The visual analogue score (VAS) at rest and cough extubation immediately and 1, 6, 12, 24, 48 h after extubation were recorded. The compression number of analgesia pump, remedy number of sufentanil and incidence of adverse events 48 h after extubation were recorded. The levels of venous blood norepinephrine (NE), epinephrine (E) and cortisol immediately after surgery and 24 h after extubation were measured. Results Sixty patients completed the study. There were no statistical difference in intraoperative fluid volume, operation duration, MAP, heart rate, SPI, RE, SE, incidence of adverse events (nausea vomiting, urinary retention and itching) and remedy number of sufentanil (P>0.05). Compared with control group, the rest VAS from extubation immediately to 48 h after extubation and cough VAS from extubation immediately to 24 h after extubation in combined group 1 and 2 were signi
作者 郑艳雅 卓谦 姜辉 王明 吴艳琴 Zheng Yanya;Zhuo Qian;Jiang Hui;Wang Yue;Wu Yanqin(Department of Anesthesiology, Wenzhou People′s Hospital, Zhejiang Wenzhou 325000, China)
出处 《中国医师进修杂志》 2019年第5期448-453,共6页 Chinese Journal of Postgraduates of Medicine
基金 浙江省温州市科技计划项目(Y20180575)。
关键词 神经传导阻滞 胸腔镜 肺切除术 疼痛 手术后 前瞻性研究 Nerve block Thoracoscopes Pneumonectomy Pain, postoperative Prospective studies
作者简介 通信作者:吴艳琴,Email: zhengxianya@163.com,电话:0577-88059897。
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