竖脊肌平面阻滞在老年胸腔镜肺叶切除术患者中的应用效果

Effect of erector spinae plane block in elderly patients undergoing thoracoscopic lobectomy

摘要:

目的 分析竖脊肌平面阻滞在老年胸腔镜肺叶切除术中的应用效果。方法 选取2021年2月—2023年3月胜利油田中心医院行胸腔镜肺叶切除术的98例患者，采用随机数字表法分为对照组和研究组，每组49例。研究组给予竖脊肌平面阻滞联合无阿片类药物全身麻醉，对照组给予阿片类全身麻醉。比较两组T₀（麻醉诱导前）、T₁（气管插管时）、T₂（切皮时）、T₃（手术结束）的平均动脉压、心率，对比两组手术情况、术后疼痛、苏醒期间躁动情况及药物不良反应情况。结果 两组T₀、T₁、T₂、T₃的平均动脉压比较，结果 ①不同时间点的平均动脉压比较，差异有统计学意义（P <0.05）；②两组平均动脉压比较，差异无统计学意义（P >0.05）；③两组平均动脉压的变化趋势比较，差异无统计学意义（P >0.05）。两组T₀、T₁、T₂、T₃时刻心率比较，结果 ①不同时间点的心率比较，差异有统计学意义（P <0.05）；②两组心率比较，差异无统计学意义（P >0.05）；③两组心率的变化趋势比较，差异无统计学意义（P >0.05）。两组手术时间比较，差异无统计学意义（P >0.05）。研究组术后苏醒时间、拔管时间短于对照组（P <0.05）。两组术后4、12、24和48 h的疼痛视觉模拟评分（VAS）比较，结果 ①不同时间点的VAS评分比较，差异有统计学意义（P <0.05）；②两组VAS评分比较，差异有统计学意义（P <0.05），研究组低于对照组，相对镇痛效果较好；③两组VAS评分的变化趋势比较，差异有统计学意义（P <0.05）。研究组苏醒期躁动发生率低于对照组（P <0.05）。研究组不良反应总发生率低于对照组（P <0.05）。结论 竖脊肌平面阻滞用于老年胸腔镜肺叶切除术安全可行，可避免使用阿片类药物，并可减轻术后疼痛，降低苏醒期躁动发生风险，减少围手术期不良反应，有利于患者快速康复。

Abstract:

Objective To analyze the effect of erector spinae plane block in elderly patients undergoing thoracoscopic lobectomy.Methods Ninety-eight patients who underwent thoracoscopic lobectomy in our hospital from February 2021 to March 2023 were selected and divided into the control group and the study group by random number table method, with 49 cases in each group. The study group was given erector spinae plane block combined with opioid-free general anesthesia, and the control group was given opioid-free general anesthesia. The mean arterial pressure and heart rate at T₀ (before anesthesia induction), T₁ (at endotracheal intubation), T₂ (at skin incision making) and T₃ (at the end of the operation) in the two groups were compared. The surgery-related conditions, postoperative pain, agitation during recovery and adverse drug reactions were compared between the two groups.Results The comparison of mean arterial pressure at T₀, T₁, T₂ and T₃ in the two groups showed that the mean arterial pressure was different among the time points (P < 0.05) but not between the two groups (P > 0.05), and that the change trend of mean arterial pressure was not different between the two groups (P > 0.05). The comparison of heart rate at T₀, T₁, T₂ and T₃ in the two groups demonstrated that the heart rate was different among the time points (P < 0.05) but not between the two groups (P > 0.05), and that the change trend of heart rate was not different between the two groups (P > 0.05). There was no difference in the operative duration between the two groups (P >0.05). The postoperative recovery time and extubation time of the study group were shorter than those of the control group (P < 0.05). The comparison of the Visual Analogue Scale (VAS) scores at 4 h, 12 h, 24 h and 48 h after the surgery in the two groups exhibited that the VAS scores were different among the time points (P < 0.05) and between the two groups (P < 0.05), and that the VAS scores in the study group were lower than those in the control group, indicating better analgesic effects. The change trends of the VAS scores were different between the two groups (P <0.05). The incidence of emergence agitation in the study group was lower than that in the control group (P <0.05). The overall incidence of adverse reactions in the study group was lower than that in the control group (P < 0.05).Conclusion Erector spinae plane block is safe and feasible for thoracoscopic lobectomy in elderly patients. It avoids the use of opioids, reduces postoperative pain, the risk of emergence agitation, and perioperative adverse reactions, and facilitates rapid recovery of patients.