超声引导下连续竖脊肌平面阻滞对开胸食管癌根治术患者自控镇痛效果的影响
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摘要
目的探讨超声引导下连续竖脊肌平面阻滞(CESP)在开胸食管癌根治术术后的镇痛效果。方法择期行开胸食管癌根治术患者40例,性别不限,年龄51～76岁,体重61～78 kg,心功能Ⅰ～Ⅱ级,ASAⅠ～Ⅱ级。按照随机数字表法将患者随机分为两组:连续竖脊肌平面阻滞自控镇痛组(CE组)和静脉自控镇痛组(P组),每组20例。CE组患者在全麻诱导前行超声引导下竖脊肌平面阻滞并置管,P组患者不进行竖脊肌平面阻滞。两组患者均行全凭静脉麻醉。CE组患者术后镇痛配方为0.2%罗哌卡因150 mL,参数设置:首次量8 mL、背景量8 mL/h、单次剂量8 mL、锁定30 min。P组患者术后镇痛配方为舒芬太尼150μg+托烷司琼4 mg+生理盐水至150 mL,参数设置:首次量1 mL、背景量3 mL/h、单次剂量1 mL、锁定30 min。两组患者均于手术结束后立即使用自控镇痛至术后48 h。若静息或活动时VAS≥4分启动自控按钮给予一次自控镇痛剂量的镇痛药,若无缓解则给予舒芬太尼5μg作为补救镇痛。记录患者术后4、8、12、24、48 h视觉模拟(VAS)静态和动态评分,同时采用舒适评分(BCS)评价患者镇痛满意度;记录患者不同时点镇痛泵有效按压次数,记录患者术后48 h内补救镇痛率、患者不良反应发生率。结果 CE组患者术后4、8、12、24、48 h VAS静态和动态评分明显低于P组,差异有统计学意义(P<0.05);CE组患者术后4、8、12、24、48 h BCS评分明显高于P组,差异有统计学意义(P<0.05);CE组镇痛泵自主按压次数明显少于P组,差异有统计学意义(P<0.05);CE组术后恶心呕吐(PONV)发生率、术后镇痛补救率明显低于P组,差异有统计学意义(P<0.05)。结论超声引导下CESP镇痛方式较PCIA镇痛方式更为确切有效。
引文
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[13] Chin KJ,Adhikary S,Sarwani N,et al.The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair[J].Anaesthesia,2017,72(4):452-460.
[14] De la Cuadra-Fontaine JC,Concha M,Vuletin F,et al.Continuous arector spinae plane block for thoracic surgery in a pediatric patient[J].Paediatr Anaesth,2018,28(1):74-75.
[15] El-Boghdadly K,Pawa A.The erector spinae block;piane and simple[J].Anaesthesia,2017,72(4):434-438.
[2] Forero M,Adhikary SD,Lopez H,et al.The erector spinae plane block:a novel analgesic technique in thoracic neuropathic pain[J].Reg Anesth Pain Med,2016,41(5):621-627.
[3] Forero M,Rajarathinm M,Adhikary S,et al.Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure:A Case Report[J].A A Case Rep,2017,8 (10):254-256.
[4] 马丹旭,任惠龙,芮燕,等.超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响[J].临床麻醉学杂志,2017,33(10):965-967.
[5] Mazwell C,Nicoara A.New developments in the treatment of acute pain after thoracic surgery[J].Curr Opin Anaesthesiol,2014,27(1):6-11.
[6] 冯勇,赵玲,陈洪昌,等.自控硬膜外镇痛对食管癌术后肺部感染的影响[J].中华医院感染学杂志,2005,15(9):1003-1005.
[7] 刘建民,张新叶,王保收,等.食管癌术后并发肺部感染临床分析与防治策略[J].河南大学学报:医学版,2013,32(2):147-148.
[8] Gottschalk A,Cohen SP,Yang S.Preventing and treating pain after thoracic surgery[J].Anesthesiology,2006,104(3):594-600.
[9] Muňoz F,Cubillos J,Bonilla AJ,et al.Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgry[J].Can J Anaesth,2017,64(8):880-882.
[10] Ueshima H,Otake H.Clinical experiences of erector spinae plane block for children[J].J Clin Anesth,2017,44:41.
[11] Forero M,Rajarathinam M,Adhikary S,et al.Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome:A case series[J].Scand J Pain,2017,17(1):325-329.
[12] Chin KJ,Malhas L,Perlas A.The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery:A Report of 3 Cases[J].Reg Anesth Pain Med,2017,42(3):372-376.
[13] Chin KJ,Adhikary S,Sarwani N,et al.The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair[J].Anaesthesia,2017,72(4):452-460.
[14] De la Cuadra-Fontaine JC,Concha M,Vuletin F,et al.Continuous arector spinae plane block for thoracic surgery in a pediatric patient[J].Paediatr Anaesth,2018,28(1):74-75.
[15] El-Boghdadly K,Pawa A.The erector spinae block;piane and simple[J].Anaesthesia,2017,72(4):434-438.