超声引导下双侧竖脊肌平面阻滞联合全麻在微创漏斗胸修复术中的应用

Application of bilateral ultrasound-guided erector spinae plane block combined with general anesthesia in patients undergoing minimally invasive repair of pectus excavatum

中文关键词: 漏斗胸  微创漏斗胸矫形术  双侧竖脊肌平面阻滞  术后镇痛

英文关键词: Pectus excavatum  Minimally invasive repair of pectus excavatum  Bilateral erector spinae plane block  Postoperative analgesic

中文摘要:

      
目的 观察超声引导下双侧竖脊肌平面阻滞（ESPB）联合全身麻醉应用于微创漏斗胸修复术（MIRPE）的安全性和有效性。
方法 选择2018年3月至2020年3月行MIRPE的青少年患者60例，男52例，女8例，年龄14~18岁，BMI 15~23 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将青少年患者分为两组：ESPB联合全麻组（E组）和单纯全麻组（G组），每组30例。E组在麻醉诱导前行超声引导下双侧ESPB，G组行单纯全麻，两组麻醉方法相同。记录术中瑞芬太尼用量、术后2、6、12、24、48 h静息和运动时VAS疼痛评分、手术时间、PACU停留时间、PCIA按压次数、PCIA舒芬太尼用量和恶心、呕吐发生情况。
结果 E组术后2、6、12、24、48 h静息和运动时VAS疼痛评分均明显低于G组（P<0.05），PACU停留时间明显短于G组（P<0.05），PCIA按压次数、术后舒芬太尼用量明显少于G组（P<0.05），术后恶心、呕吐发生率明显低于G组（P<0.05）。
结论 超声引导下双侧竖脊肌平面阻滞联合全麻可安全有效地应用于微创漏斗胸修复术。

英文摘要:

      
Objective To observe the safty and effectiveness of bilateral ultrasound guided erector spinae plane block (ESPB) combined with general anesthesia in patients undergoing minimally invasive repair of pectus excavatum (MIRPE).
Methods Sixty patients scheduled for MIRPE procedure from March 2018 to March 2020 were enrolled, 52 males and 8 females, aged 14-18 years, BMI 15-23 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups： ESPB combined with general anesthesia group (group E) and general anesthesia group (group G), 30 patients in each group. Before general anesthesia induction, bilateral ultrasound-guided ESPB were performed in group E, group G did general anesthesia only. Both groups adopted the same method for general anesthesia. The consumption of remifentanil, the VAS scores at rest and during exercise 2, 6, 12, 24, and 48 hours after operation, operation time, duration of stay in PACU, the frequency of compress PCIA, the consumption of sufentanil in PCIA, the rate of nausea and vomiting were recorded.
Results The VAS scores at rest and during exercise 2, 6, 12, 24, and 48 hours after operation in group E were lower than those in group G(P < 0.05). The duration of stay in PACU in group E were significantly shorter than that in group G (P < 0.05). The frequency of compress PCIA, the consumption of sufentanil in PCIA, the rate of nausea and vomiting in group E were significantly less than those in group G (P < 0.05).
Conclusion The bilateral ultrasound guided ESPB combined with general anesthesia is safely and effectively applied to MIRPE．