摘要
目的:评价超声引导下前锯肌平面阻滞(SAPB)对胸腔镜(VATS)肺叶切除术后氧合功能及并发症的影响。方法:选取2020—2023年昆山市中医医院行VATS肺叶切除术的68例患者作为研究对象,随机分为观察组(SP组)和对照组(P组)。SP组所有患者在全麻诱导前30 min,采用0.4%罗哌卡因120 mg+地塞米松5 mg行术侧超声引导下前锯肌平面阻滞(SAPB),P组不做特殊处理。比较两组患者不同时间点的氧合功能,围术期镇痛情况,术后肺部并发症和不良反应的发生情况。结果:与P组相比,SP组患者t_(2)、t_(3)、t_(4)和t_(5)时点的术后氧合指数(OI)均明显升高,差异有统计学意义(t=2.19、2.22、3.01、2.47,P<0.05);与P组相比,SP组患者术后48 h内经静脉自控镇痛(PCIA)首次按压时间明显延长;术中瑞芬太尼用量,有效按压次数,补救镇痛率,曲马多用量明显减少,差异有统计学意义(t=46.08、2.81、23.08、5.87,P<0.05);与P组相比,SP组患者麻醉苏醒时间明显缩短,苏醒期躁动、肺不张、低氧血症、术后恶心呕吐、头晕的发生率明显降低,差异有统计学意义(t=13.46;χ^(2)=6.91、4.51、5.04、4.51、5.67,P<0.05)。结论:超声引导下前锯肌平面阻滞用于胸腔镜肺叶切除术,可提高术后氧合指数,减少围术期镇痛药物的消耗量,降低术后并发症的发生率。
Objective:To investigate the effect of ultrasound-guided serratus anterior plane block(SAPB)on postoperative oxygenation and complications in patients under thoracoscopic lobectomy.Methods:68 patients who underwent thoracoscopic lobectomy in the hospital from 2020 to 2023 were randomly divided into two groups:observation group(group SP)and control group(group P).30 min before general anesthesia induction,all patients in group SP were performed with SAPB of the operative side using 0.4%ropivacaine 120 mg combined with dexamethasone 5 mg,and no special treatment was performed in group P.Oxygenation at different times,perioperative analgesia and the occurrence of postoperative pulmonary complications and adverse reactions between the two groups were compared.Results:Compared with group P,the postoperative oxygenation index(OI)of patients in group SP at t_(2),t_(3),t_(4) and t_(5) time points were significantly increased,and the difference was statistically significant(t=2.19,2.22,3.01,2.47;P<0.05).Compared with group P,the first compression time of PCIA in group SP was significantly longer within 48 h after operation.Intraoperative dosage of remifentanil,effective compression times,remedial analgesia rate,tramadol dosage decreased significantly,and the difference was statistically significant(t=46.08,2.81,23.08,5.87;P<0.05).Compared with group P,the anesthesia recovery time of patients in group SP was significantly shortened,and the incidence of agitation,atelectasis,hypoxemia,PONV and dizziness during the recovery period were significantly reduced,with statistically significant difference(t=13.46;χ2=6.91,4.51,5.04,4.51,5.67;P<0.05).Conclusion:Ultrasound-guided serratus anterior plane block can improve the pulmonary oxygenation,reduce analgesic,and decrease the incidence of adverse reactions in patients undering thoracoscopic lobectomy.
作者
赵赢
李蓉
潘鹏
张代玲
Zhao Ying;Li Rong;Pan Peng(Department of Anesthesiology,Traditional Chinese Medicine Hospital of Kunshan,Kunshan,Jiangsu,215300,China)
出处
《黑龙江医学》
2024年第21期2585-2588,共4页
Heilongjiang Medical Journal
关键词
前锯肌平面阻滞
胸腔镜
镇痛
氧合
并发症
Serratus anterior plane block
Thoracoscope
Analgesia
Oxygenation
Complication
