超声引导竖脊肌平面阻滞对乳腺肿物切除术后镇痛作用效果的研究

邓立平 李长红 林少锋

【摘要】 目的探討超声引导竖脊肌平面阻滞（ESPB）对乳腺肿物切除术患者术后的镇痛效果。方法 51例择期行乳腺肿物切除术的患者， 采用随机数字表法将患者分为A组（26例）和C组（25例）。A组在术后行超声引导下T5水平单点单次竖脊肌平面阻滞， C组不实施竖脊肌平面阻滞。比较两组不同时间[术后2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）]的镇静评分、疼痛数字评分法（NRS）评分及术后24 h内吗啡总用量、满意度、不良反应发生情况。结果 两组各个时间点镇静评分比较差异无统计学意义（P>0.05）。A组T1、T2、T3、T4、T5 的NRS评分均低于C组， 差异有统计学意义（P<0.05）。A组术后24 h内吗啡总用量为（2.2±1.3）mg， 少于C组的（6.5±3.8）mg， 差异有统计学意义（P<0.05）。A组非常满意度84.0%高于C组的46.2%， 差异有统计学意义（P<0.05）。两组不良反应发生率比较， 差异无统计学意义（P>0.05）。两组均未发生呼吸抑制、血压降低、神经损伤等严重不良反应。结论 乳腺肿物切除术患者采用竖脊肌平面阻滞可以有效减轻术后疼痛及减少术后吗啡用药量， 患者满意度高， 且未发生明显不良反应。

【关键词】 乳腺肿物切除术;竖脊肌平面阻滞;超声引导;术后镇痛

DOI：10.14163/j.cnki.11-5547/r.2020.20.008

【Abstract】 Objective   To discuss the analgesic effect of ultrasound-guided erector spinae plane block （ESPB） after breast lumpectomy. Methods   A total of 51 patients with selective breast lumpectomy were divided into group A （26 cases） and group C （25 cases） by random numerical table. Group A received single point erector spinae plane block at T5 level under the guidance of ultrasound， and group C received no erector spinae plane block. The sedation score， numerical rating score （NRS） score at different time points [2 h after surgery （T1）， 4 h after surgery （T2）， 8 h after surgery （T3）， 12 h after surgery （T4）， 24 h after surgery （T5）]， total dosage of morphine within 24 h after surgery， satisfaction and the occurrence of adverse reactions were compared between the two groups. Results   There was no statistically significant difference in sedation score at different time points between the two groups （P>0.05）. NRS score at T1， T2， T3， T4 and T5 of group A was lower than those of group C， and the difference was statistically significant （P<0.05）. The total dosage of morphine within 24 h after surgery of group A was （2.2±1.3） mg， which was less than that of group C （6.5±3.8） mg， and the difference was statistically significant （P<0.05）. The very satisfaction rate 84.0% of group A was higher than that of group C 46.2%， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in incidence of adverse reactions between the two groups （P>0.05）. No serious adverse reactions such as respiratory depression， blood pressure reduction， and nerve damage occurred in both groups. Conclusion   Application of erector spinae plane block in patients with breast lumpectomy can effectively reduce postoperative pain and reduce the dosage of postoperative morphine. The patients satisfaction is high and no obvious adverse reactions have occurred.

【Key words】 Breast lumpectomy; Erector spinae plane block; Ultrasound-guided; Postoperative analgesia

乳腺肿物切除手术虽然时间短、创伤小、恢复快， 但仍存在术后伤口疼痛的不良反应[1]。减轻患者术后疼痛不仅可以降低并发症发生， 而且有助于患者术后恢复。同时也符合快速康复的理念 [2]。术后镇痛常用药物为阿片及非甾体类药物， 其便秘、恶心、呕吐或者对胃肠道刺激都较明显。竖脊肌平面阻滞作为外周神经阻滞技术在西方国家已有成熟应用。2016年， Forero等[3]首次报道了竖脊肌平面阻滞术， 将其应用于胸背部神经病理性疼痛的治疗， 将0.5%罗哌卡因20 ml注射于竖脊肌深面T5横突上， 可阻滞同侧T3～9脊神经区域， 获得了良好的效果。本文……