联合区域神经阻滞对单孔胸腔镜肺楔形切除术后疼痛的影响

Application of combined regional nerve block on pain after single-hole thoracoscopic wedge resection of lung

摘要:

探讨肋间神经阻滞联合前锯肌阻滞在单孔胸腔镜肺楔形切除术后镇痛中的疗效。方法 回顾性分析西南医科大学附属医院胸外科2018年3月—2019年3月接受单孔胸腔镜肺楔形切除手术患者60例。根据接受区域阻滞方式将患者分为观察组（肋间神经阻滞+前锯肌阻滞）33例和对照组（前锯肌阻滞）27例。比较两组患者性别构成比、年龄、BMI、ASA分级、手术出血量、手术时间、术后4、12、24和48?h视觉模拟评分（VAS）、术后患者自控静脉镇痛（PCIA）泵按压次数、术后追加用药次数、术后PCIA相关副作用、术后肺部并发症、术后拔除胸管时间、术后SpO2、首次下床活动时间及住院时间。结果 两组患者一般资料、手术出血量、手术时间的差异无统计学意义（P?>0.05）；术后不同时间点的VAS评分、两组的VAS评分，两组VAS评分变化趋势差异均有统计学意义（P?<0.05）；两组术后PCIA相关副作用发生率比较，差异无统计学意义（P?>0.05）；观察组与对照组比较，减少术后PCIA泵按压次数，减少术后追加用药次数，降低术后肺部并发症发生率，缩短术后拔除胸管时间，提高术后动脉SpO2，提前首次下床活动时间，缩短住院时间（P?<0.05）。结论 与前锯肌阻滞比较，肋间神经阻滞联合前锯肌阻滞能减轻患者术后疼痛，降低患者肺部并发症，利于患者快速康复。

Abstract:

Objective To investigate the effect of intercostal nerve block and serratus plane block on analgesia after single-hole thoracoscopic wedge resection of lung. Methods A retrospective analysis was made on 60 patients who underwent single-hole thoracoscopic wedge resection from March 2018 to March 2019 in our hospital. According to the regional block method, the patients were divided into the observation group (33 cases of intercostal nerve block + serratus plane block) and the control group (27 cases of serratus plane block). The gender, age, BMI, ASA grade, bleeding volume, operation time, pain VAS score at 4, 12, 24 and 48 hours after operation, PCIA pressing times after operation, additional medication times after operation, PCIA-related side effects after operation, pulmonary complications after operation, chest tube removal time after operation, SpO2 activity time after operation, hospital stay were compared between the two groups. Results There was no significant difference in general data, bleeding volume and operation time between the two groups (P?>?0.05). The VAS scores at different time points after operation and VAS scores after operation in the two groups had statistical significance (P??0.05). Compared with the control group, the observation group reduced the times of PCIA pressing and additional medication after operation, reduced the incidence of pulmonary complications (P?