前锯肌神经阻滞复合全麻用于肺癌根治术的镇痛效果

doi:10.3760/cma.j.issn.1007-1245.2024.18.022

摘要/Abstract

摘要：

目的　探讨前锯肌神经阻滞复合全麻用于肺癌根治术的镇痛效果。方法　选择2018年12月至2022年12月期间武夷山市立医院收治的择期行肺癌根治术的患者92例作为研究对象，按随机数字表法分为两组各46例。对照组男25例，女21例，年龄（51.15±3.96）岁，体重指数（22.87±1.15）kg/m²，TNM分期：Ⅰ期8例，Ⅱ期38例；观察组男27例，女19例，年龄（51.28±4.12）岁，体重指数（22.92±1.13）kg/m²，TNM分期：Ⅰ期7例，Ⅱ期39例。对照组采取静吸复合全麻，观察组采取超声引导下前锯肌神经阻滞（麻醉诱导后，选择22G神经阻滞针进针，抵达前锯肌表面时，先给予2 ml试验剂量，见液性暗区，回抽无血、无气，再注射0.375%罗哌卡因20 ml）复合全麻。测定术中、术后不同时间点两组的心率（HR）、收缩压（SBP）、舒张压（DBP）变化，记录术后舒芬太尼用量、术后苏醒时间、恢复自主呼吸时间、自控静脉镇痛按压次数，评价术后不同时间点疼痛程度，观察不良反应发生情况。采用t检验、χ²检验。结果　诱导前（T0）、划皮时（T1）、手术30 min（T2），两组HR、SBP、DBP比较差异均无统计学意义（均P>0.05）；苏醒期拔管即刻（T3）、拔管后5 min（T4），观察组HR、SBP、DBP均低于对照组（均P<0.05）。观察组术后舒芬太尼用量［（10.22±2.54）μg比（20.52±4.58）μg］、术后苏醒时间［（15.02±3.06）min比（22.58±4.72）min］、恢复自主呼吸时间［（16.82±3.34）min比（25.75±4.18）min］、自控静脉镇痛按压次数［（10.22±2.27）次比（18.72±3.72）次］均低于对照组（均P<0.05）。术后6 h、12 h、24 h、48 h观察组静息、活动时疼痛评分均低于对照组（均P<0.05）。观察组不良反应发生率低于对照组［6.52%（3/46）比23.91%（11/46）］（χ²=5.391，P=0.020）。结论　肺癌根治术采取超声引导下前锯肌神经阻滞复合全麻可维持术中血流动力学稳定，减轻术后疼痛程度，减少麻醉药物用量和自控静脉镇痛按压次数，促进术后快速康复，减少麻醉不良反应，值得推广应用。

关键词:

肺癌, 前锯肌神经阻滞, 全麻, 自控静脉镇痛, 不良反应

Abstract:

Objective　To explore the analgesic effect of anterior serratus nerve block combined with general anesthesia for radical resection of lung cancer. Methods　A total of 92 patients admitted to Wuyishan Municipal Hospital from December 2018 to December 2022 for elective radical resection of lung cancer were selected as the study objects, and were divided into two groups according to the random number table method, with 46 cases in each group. In the control group, there were 25 males and 21 females, aged (51.15±3.96) years, with a body mass index of (22.87±1.15) kg/m², and the TNM stage was stage I in 8 cases and stage II in 38 cases. In the observation group, there were 27 males and 19 females, aged (51.28±4.12) years, with a body mass index of (22.92±1.13) kg/m², and the TNM stage was stage I in 7 cases and stage II in 39 cases. The control group received combined intravenous and inhalation general anesthesia, and the observation group received ultrasound-guided anterior serratus nerve block (after anesthesia induction, 22G nerve block needle was used, and when it reached the surface of the anterior serratus muscle, 2 ml of ropivacaine was given firstly, and then 20 ml of 0.375% ropivacaine was injected after liquid dark area was found, and no blood or air was withdrawn) combined with general anesthesia. The changes of heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of the two groups were measured at different time points during operation and after operation. The amount of postoperative sufentanil use, postoperative awakening time, recovery time of spontaneous breathing, and number of times of self-controlled intravenous analgesia compressions were recorded, the pain degree was evaluated at different time points after operation, and the occurrence of adverse reactions was observed. t test and χ² test were used. Results　There were no statistically significant differences in the HR, SBP, or DBP between the two groups before induction (T0), at incision (T1), or 30 min after operation (T2) (all P>0.05); the HR, SBP, and DBP in the observation group were lower than those in the control group immediately after extubation (T3) and 5 min after extubation (T4) (all P<0.05). The amount of postoperative sufentanil use [(10.22±2.54) μg vs. (20.52±4.58) μg], postoperative awakening time [(15.02±3.06) min vs. (22.58±4.72) min], recovery time of spontaneous breathing [(16.82±3.34) min vs. (25.75±4.18)] min], and number of times of self-controlled intravenous analgesia compressions [(10.22±2.27) vs. (18.72±3.72)] in the observation group were lower than those in the control group (all P<0.05). The pain scores at rest and under activity in the observation group were lower than those in the control group 6 h, 12 h, 24 h, and 48 h after surgery (all P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group [6.52% (3/46) vs. 23.91% (11/46)] (χ²=5.391, P=0.020). Conclusion　The use of ultrasound-guided anterior serratus nerve block combined with general anesthesia can maintain the stability of intraoperative hemodynamics, reduce the degree of postoperative pain, reduce the dosage of anesthetic drugs and the number of self-controlled intravenous analgesic compressions, promote the rapid postoperative recovery, and reduce the anesthesia related adverse reactions, which is worthy of popularization and application.

Key words:

Lung cancer, Anterior serratus nerve block, General anesthesia, Self-controlled intravenous analgesia, Adverse reactions

武琳廖燕凌.

前锯肌神经阻滞复合全麻用于肺癌根治术的镇痛效果 [J]. 国际医药卫生导报, 2024, 30(18): 3094-3098.

Wu Lin, Liao Yanling.

Analgesic effect of anterior serratus nerve block combined with general anesthesia for radical resection of lung cancer [J]. International Medicine and Health Guidance News, 2024, 30(18): 3094-3098.

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