摘要
目的比较3种浓度罗哌卡因B超引导单次竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的效果。方法择期行胸腔镜手术患者120例,ASAⅠ~Ⅱ级,年龄21~64岁,分为对照组(C组)、0.25%罗哌卡因组(Ⅰ组)、0.33%罗哌卡因组(Ⅱ组)、0.50%罗哌卡因组(Ⅲ组),每组30例。试验组患者于麻醉诱导前行单次竖脊肌平面阻滞,对照组不行此操作,均采用全身麻醉。观察各组患者麻醉前、手术30 min、术毕、术后24 h的无创血压(MAP)、心率(HR)。记录患者术后1 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)及48 h(T5)的静息和咳嗽时舒适度(BCS)评分,镇痛泵有效按压、追加曲马多、不良反应、并发症及患者的满意度情况。结果试验组大部分患者平面为T2~T9脊神经支配区域。与C组比较,Ⅱ组和Ⅲ组T1~T5时BCS评分升高,Ⅰ组、Ⅱ组和Ⅲ组丙泊酚及瑞芬太尼用量减少,追加曲马多、镇痛泵有效按压少,满意度高,差异有统计学意义(P<0.05)。与Ⅰ组比较,Ⅱ组和Ⅲ组T3~T5时BCS评分升高,追加曲马多、镇痛泵有效按压及恶心呕吐少,满意度高,差异有统计学意义(P<0.05)。所有患者未见全脊麻及局部麻醉药中毒病例。结论0.25%、0.33%、0.50%罗哌卡因B超引导单次竖脊肌平面阻滞可安全有效用于胸腔镜手术患者术后镇痛,0.33%罗哌卡因较适合临床应用。
Objective To observe the analgesia effect of ultrasound guided erector spinae plane block with different concentrations of ropivacaine on postoperative analgesia in patients undergoing thoracoscopic surgery.Methods A total of 120 patients undergoing thoracoscope surgery,ASAⅠorⅡlevel,age 21-64,were divided into three groups:the control group(group C),the 0.25%ropivacaine group(groupⅠ),the 0.33%ropivacaine group(groupⅡ)and the 0.50%ropivacaine group(groupⅢ),with 30 cases in each group.Patients in the experiment group received single plane block of the erector spine muscle before anesthesia induction,while those in the control group did not.All patients received general anesthesia.The noninvasive blood pressure(MAP),heart rate(HR)were observed before anesthesia,30 min after the start of operation,after operation,and postoperative 2 h.Bruggrmann comfort scale(BCS)score when rest and cough at postoperative 1 h(T1),6 h(T2),12 h(T3),24 h(T4)and 48 h(T5),effective presses of analgesic pump,addition of tramadol medication,adverse reactions and ESP related complications,patients′satisfaction postoperative were recorded.Results In the experiment group,the plane was T2-T9 spinal innervation area in mostpatients.Compared with group C,T1-T5 BCS score increased in groupⅡ,Ⅲ,addition of propofol and remifentanil,effective presses of analgesic pump decreased and satisfaction increased in groupⅠ,Ⅱ,Ⅲ(P<0.05).Compared with groupⅠ,T3-T5 BCS score increased,addition of tramadol,effective presses of analgesic pump and nausea and vomiting cases decreased,satisfaction increased in groupⅡ,Ⅲ(P<0.05).All groups had no poisoning cases of whole spinal anesthesia and local anesthetic.Conclusion Ultrasound guided erector spinae plane block with ropivacaine concentrations of 0.25%,0.33%and 0.50%had postoperative analgesia effect in patients undergoing thoracoscopic surgery.The concentration of ropivacaine 0.33%is more suitable for clinical application.
作者
周桥灵
戴鹏
刘洪珍
赵伟成
贺俭
梁桦
王汉兵
ZHOU Qiaoling;DAI Peng;LIU Hongzhen;ZHAO Weicheng;HE Jian;LIANG Hua;WANG Hanbing(Department of Analgesia,the Affiliated Foshan Hospital of Sun Yat-sen University,Foshan,Guangdong 528000,China)
出处
《重庆医学》
CAS
2020年第7期1078-1081,共4页
Chongqing medicine
基金
广东省临床重点专科建设资金项目(粤卫[2011]144)
广东省科技厅项目(2014A020212003)
佛山市十三五高水平重点专科项目(FSGSPZD135005)
佛山市医学类科技攻关项目(2015AB00301)。
关键词
竖脊肌平面阻滞
罗哌卡因
胸腔镜手术
超声
erector spinae plane block
ropivacaine
thoracoscopic surgery
ultrasound
