[1]杨五臣,邵海涛,王蒙飞.超声引导下椎旁神经阻滞与胸横肌平面阻滞在心脏瓣膜置换患者中的应用效果比较[J].新乡医学院学报,2023,40(1):079-83.[doi:10.7683/xxyxyxb.2023.01.014]
　YANG Wuchen,SHAO Haitao,WANG Mengfei.Comparison of the application effect of ultrasound-guided paravertebral nerve block and transverse pectoral muscle plane block in patients with heart valve replacement[J].Journal of Xinxiang Medical University,2023,40(1):079-83.[doi:10.7683/xxyxyxb.2023.01.014]
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超声引导下椎旁神经阻滞与胸横肌平面阻滞在心脏瓣膜置换患者中的应用效果比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年1期
页码:
079-83
栏目:
临床研究
出版日期:
2023-01-05

文章信息/Info

Title:
Comparison of the application effect of ultrasound-guided paravertebral nerve block and transverse pectoral muscle plane block in patients with heart valve replacement
作者:
杨五臣; 邵海涛; 王蒙飞
（河南省人民医院心脏中心/华中阜外医院/郑州大学华中阜外医院麻醉科,河南　郑州　450000)
Author(s):
YANG Wuchen; SHAO Haitao; WANG Mengfei
（Department of Anesthesiology,Heart Center of Henan Provincial People′s Hospital,Huazhong Fuwai Hospital,Huazhong Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China）
关键词:
心脏瓣膜置换术; 全身麻醉; 椎旁神经阻滞; 胸横肌平面阻滞; 疼痛程度
Keywords:
heart valve replacement; general anesthesia; paravertebral nerve block; transverse pectoral muscle plane block; degree of pain
分类号:
R654.2
DOI:
10.7683/xxyxyxb.2023.01.014
文献标志码:
A
摘要:
目的　比较超声引导下椎旁神经阻滞与胸横肌平面阻滞在心脏瓣膜置换患者中的应用价值。方法　选择2019年10月至2021年10月于华中阜外医院行心脏瓣膜置换术患者100例为研究对象，将患者随机分为观察组和对照组，每组50例。观察组患者于超声引导下行椎旁神经阻滞，对照组患者于超声引导下行胸横肌平面阻滞，2组患者均于神经阻滞完成后接受全身麻醉。比较2组患者气管插管时（T1）、劈胸骨时（T2）、切开心包时（T3）、关胸时（T4）的血流动力学指标心率（HR）和平均动脉压（MAP）；分别于麻醉苏醒后6 h（T5）、苏醒后12 h（T6）、苏醒后24 h（T7）、苏醒后48 h（T8）时采用视觉模拟评分法（VAS）评估2组患者的镇痛效果，记录并比较2组患者镇痛药物使用剂量、镇痛泵按压次数及麻醉苏醒后48 h内不良反应发生情况。结果　2组患者T2、T3、T4时的HR和MAP均显著低于T1时（P<0.05）；2组患者T3、T4时的HR和MAP均显著低于T2时（P<0.05）；对照组患者T4时的HR和MAP显著低于T3时（P<0.05），观察组患者T4时的HR显著低于T3时（P<0.05）；观察组患者T4与T3时的MAP比较差异无统计学意义（P>0.05）。2组患者T1时HR、MAP比较差异无统计学意义（P>0.05）；观察组患者T2、T3、T4时的HR和MAP均显著高于对照组（P<0.05）。观察组与对照组患者T5时的VAS评分比较差异无统计学意义（P>0.05）；对照组患者T6~T8时的VAS评分均显著高于观察组（P<0.05）。2组患者T5~T8时的VAS评分处于升高趋势，组内不同时间点之间两两比较差异均有统计学意义（P<0.05）。观察组患者镇痛药物使用剂量和镇痛泵按压次数显著少于对照组（P<0.05）。观察组和对照组患者总不良反应发生率分别为6%（3/50）、10%（5/50）；2组患者总不良反应发生率比较差异无统计学意义（χ2=0.136，P>0.05）。结论　在心脏瓣膜置换术中，与胸横肌平面阻滞相比，超声引导下椎旁神经阻滞更好地维持血流动力学稳定，减轻术后疼痛，还可减少镇痛药物使用剂量和镇痛泵按压次数。
Abstract:
Objective　To compare the application value of ultrasound-guided paravertebral nerve block and transverse pectoral muscle plane block in patients with heart valve replacement.Methods　A total of 100 patients with heart valve replacement admitted to Huazhong Fuwai Hospital from October 2019 to October 2021 were selected as the study subjects.The patients were randomly divided into observation group and control group,with 50 cases in each group.The patients in the observation group received paravertebral nerve block under ultrasound guidance,and the patients in the control group received transverse pectoral muscle plane block under ultrasound guidance.The patients in both groups received general anesthesia after completing the nerve block.The hemodynamic indexes of heart rate (HR) and mean arterial pressure (MAP) were compared between the two groups at the time points of tracheal intubation (T1),osteotomy (T2),pericardiectomy (T3) and chest closure (T4).The analgesic effect of patients in the two groups were evaluated by visual analogue scale (VAS) at the time points of 6 h (T5),12 h (T6),24 h (T7) and 48 h (T8) after awakening from anesthesia;the analgesic drug dosage,the times of pressing the analgesic pump and the adverse reactions within 48 hours after recovery from anesthesia were recorded and compared between the two groups.Results　The HR and MAP of patients at T2,T3 and T4 were significantly lower than those at T1 in the two groups(P<0.05);the HR and MAP of patients at T3,T4 were significantly lower than those at T2 in the two groups(P<0.05);the HR and MAP of patients at T4 were significantly lower than those at T3 in the control group(P<0.05);the HR of patients at T4 was significantly lower than that at T3 in the observation group(P<0.05);there was no significant difference in MAP between T4 and T3 time points in the observation group (P>0.05).There was no significant difference in HR and MAP of patients between the two groups at T1 (P>0.05);the HR and MAP of patients in the observation group were significantly higher than those in the control group at T2,T3 and T4 time points (P<0.05).There was no significant difference in VAS scores of patients between the observation group and the control group at T5 time point (P>0.05)；the VAS scores of patients in the control group were significantly higher than those in the observation group at T6-T8 time points (P<0.05).The VAS scores of patients in the two groups showed an upward trend at T5-T8,and there was significant difference between any two time points(P<0.05).The dosage of analgesic drugs and the the times of pressing the analgesic pump of patients in the observation group were significantly less than those in the control group (P<0.05).The total incidence of adverse reactions of patients in the observation group and the control group was 6% (3/50) and 10% (5/50),respectively;there was no significant difference in the total incidence of adverse reactions between the two groups（χ2=0.136，P>0.05）.Conclusion　In heart valve replacement surgery,compared with transverse pectoral muscle plane block,the ultrasound-guided paravertebral nerve block can better maintain hemodynamic stability,reduce postoperative pain,reduce the dosage of analgesic drugs and the times of pressing the analgesic pump.

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更新日期/Last Update: 2023-01-05