摘要
目的探讨双侧胸横肌平面(TTP)阻滞(改良入路)复合全麻在非体外循环冠状动脉旁路移植术(OPCABG)中应用的安全性和有效性。方法回顾性分析2019年3-8月于北部战区总医院择期行OPCABG术的60例患者的临床资料,按照麻醉方式不同分为TTP阻滞复合全麻组(TTP+全麻组,n=30)和全麻组(n=30)。TTP+全麻组麻醉诱导前在超声引导下行双侧TTP阻滞(改良入路),每侧给予0.25%罗哌卡因20 ml,两组常规诱导麻醉。统计分析两组切皮前后、劈胸骨前后、闭合胸骨前后的平均动脉压(MAP)、心率(HR)的变化率,术毕时舒芬太尼总用量,入室后、手术结束时及术后2、4、6、8、10、12、16、20、24 h血气分析中的乳酸和血糖水平,术后12、24、48 h静息和运动状态下的疼痛视觉模拟评分(VAS),术后当日、第1天、第2天首次追加镇痛药物(哌替啶)的患者例数,以及术后不良反应发生情况。结果两组各时间点MAP及HR变化率比较差异无统计学意义(P>0.05)。与全麻组比较,TTP+全麻组术后2、4 h的乳酸及术后2、4、6 h的血糖水平降低,差异有统计学意义(P<0.05)。与全麻组比较,TTP+全麻组仅术后12 h静息状态下VAS评分降低,差异有统计学意义(P<0.05)。两组术毕拔管时间差异无统计学意义(P>0.05)。与全麻组比较,TTP+全麻组舒芬太尼用量明显减少,术后当日追加镇痛药物例数明显减少,差异均有统计学意义(P<0.05)。两组术后恶心、呕吐、心律失常、皮肤瘙痒、腹胀及术后3 d术区感染发生率比较,差异无统计学意义(P>0.05);TTP+全麻组术后寒战发生率明显低于全麻组,差异有统计学意义(P<0.05)。结论双侧TTP阻滞(改良入路)复合全麻能够为行OPCABG术的患者提供有效的围术期镇痛,可减少阿片类药物用量,并在一定程度上抑制应激反应,具有较好的安全性和有效性。
Objective To investigate the safety and effectiveness of bilateral transverse thoracic muscle plane(TTP)block(modified approach)combined with general anesthesia in off-pump coronary artery bypass grafting(OPCABG).Methods The clinical data of 60 patients undergoing OPCABG,selected from March to August 2019 in General Hospital of Northern Theater Command,were retrospectively analyzed and divided into TTP block with general anesthesia group(TTP+general anesthesia group,n=30)and general anesthesia group(n=30)according to anesthesia mode.Patients in TTP+general anesthesia group undergone bilateral TTP block(modified approach,0.25%ropivacaine 20 ml each side)before anesthesia induction,and both groups were induced by routine anesthesia.The mean arterial pressure(MAP)and heart rate(HR)were recorded and analyzed before and after cutting,splitting and closing the sternum,and the total dosage of sufentanil at the end of operation was recorded.The levels of lactic acid and blood glucose in blood gas analysis of patients at the time they entered the room,the operation ended and at 2,4,6,8,10,12,16,20 and 24 h after the operation were recorded.The visual analogue scale(VAS)scores in resting and moving state at 12,24 and 48 h after operation were recorded.The numbers of patients who were first added analgesic drugs(pethidine)on the day,the first day and the second day after operations were recorded,and the occurrence of postoperative adverse reactions was recorded.Results Compared with general anesthesia group,the change rate of MAP and HR in TTP+general anesthesia group decreased slightly at each time point,but the difference was not statistically significant(P>0.05).The differences of lactic acid at 2 and 4 h after operation were statistically significant(P<0.05),while the differences of blood glucose at 2,4 and 6 h after operation were statistically significant(P<0.05)between two groups.Compared with general anesthesia group,the VAS scores(resting and moving state)of TTP+general anesthesia group decreased at 12 h(resting st
作者
张霄燕
张瑜
孙莹杰
范红娜
刁玉刚
Zhang Xiao-Yan;Zhang Yu;Sun Ying-Jie;Fan Hong-Na;Diao Yu-Gang(Postgraduate Training Base,General Hospital of Northern Theater Command,Jinzhou Medical University,Jinzhou,Liaoning 121000,China;Department of Anesthesiology,General Hospital of Northern Theater Command,Shenyang 110001,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2020年第8期840-844,共5页
Medical Journal of Chinese People's Liberation Army
基金
辽宁省自然科学基金指导计划(20180551030)。
