2020 年第 8 期 第 15 卷

超声引导下竖脊肌平面阻滞对肋骨骨折患者术后早期转归的影响

Effect of ultrasound-guided plane block of erector spinae on early postoperative outcome of rib fracture patients

作者：包音王惠军李梅王古岩

英文作者：Bao Yin Wang Huijun Li Mei Wang Guyan 

单位：首都医科大学附属北京同仁医院麻醉科100730 

英文单位：Department of Anesthesiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：肋骨骨折；竖脊肌平面阻滞；全身麻醉；超声检查

英文关键词：

• 摘要：

• 目的 评价超声引导下竖脊肌平面阻滞(ESPB)对肋骨骨折患者术后早期转归的影响。方法 选取2019年2—12月首都医科大学附属北京同仁医院因胸部外伤就诊并行肋骨骨折内固定术患者60例，采用随机数字表法将患者分为全身麻醉组(G组，30例)和全身麻醉联合超声引导下ESPB组(GE组，30例)。GE组患者全身麻醉诱导后超声引导下患侧T5横突入路注射0.25％盐酸罗哌卡因20 ml进行ESPB，G组注射0.9％氯化钠注射液20 ml。术后采用氢吗啡酮行自控静脉镇痛，当疼痛视觉模拟量表评分＞3分时，静脉注射氟比洛芬酯补救镇痛。采用QoR-40量表于术前1 d和术后1、2 d评估患者术后早期恢复质量。记录术中瑞芬太尼和术后氢吗啡酮用量，记录补救镇痛和术后不良反应发生情况。结果 术前2组患者QoR-40量表评分比较差异无统计学意义(P＞0.05)，术后1、2 d时GE组QoR-40量表评分均明显高于G组［（167±7）分比（155±8）分、（175±6）分比（164±7）分］，差异均有统计学意义(均P＜0.05)。GE组术中瑞芬太尼用量、术后氢吗啡酮用量和补救镇痛率均明显低于G组［（892±113）μg比（957±105）μg、（8.21±0.25）mg比（9.52±0.13）mg、30.0%（9/30）比96.7%（29/30）］，差异均有统计学意义(均P＜0.05)。GE组术后恶心呕吐发生率低于G组［26.7%(8/30)比56.7%(17/30)］，差异有统计学意义（P＜0.05）。2组术后尿潴留、皮肤瘙痒、便秘发生率比较，差异均无统计学意义(均P＞0.05)。结论 全身麻醉联合超声引导下ESPB可以产生良好的镇痛作用，并减少术后恶心呕吐等不良反应的发生率，促进患者术后早期转归。

• Objective To evaluate the effect of ultrasound-guided erector spinae muscle block (ESPB) on early postoperative outcomes of patients with rib fractures.Methods From February to December 2019, 60 patients with rib fracture and internal fixation due to chest trauma admitted to Beijing Tongren Hospital, Capital Medical University were selected. The patients were randomly divided into general anesthesia group (group G, 30 cases) and general anesthesia combined with ultrasound-guided ESPB group (group GE, 30 cases). The patients in two groups were given ESPB under the guidance of ultrasound after induction of general anesthesia. GE group patients were injected with 0.25% ropivacaine hydrochloride 20 ml under the guidance of ultrasound on the affected side after general anesthesia induction. Group G was injected with 20 ml 0.9% sodium chloride injection. After surgery, hydromorphone was used for self-controlled intravenous analgesia. When the pain visual analog scale score was> 3, intravenous flurbiprofen axetil was used to remedy the analgesia. QoR-40 scale was used to evaluate the early recovery quality of patients before and after operation. The dosage of remifentanil and hydromorphone were recorded during the operation, and the recovery analgesia and adverse reactions were recorded. Results There was no significant difference in QoR-40 score between two groups before operation (P＞0.05). The QoR-40 score of group GE were significantly higher than those of group G at 1 and 2 days after operation［（167±7） vs （155±8）,（175±6） vs （164±7）］ (both P＜0.05). The dosage of remifentanil, the dosage of hydromorphone and the rate of remedial analgesia in group GE were significantly lower than those in group G［（892±113）μg vs （957±105）μg,（8.21±0.25）mg vs （9.52±0.13）mg,30.0%（9/30） vs 96.7%（29/30）］ (all P＜0.05). The incidence of postoperative nausea and vomiting in group GE was lower than that in group G ［26.7%(8/30) vs 56.7%(17/30)］(P＜0.05). There was no significant difference in the incidence of postoperative urinary retention, pruritus and constipation between the two groups (P＞0.05). Conclusions General anesthesia combined with ultrasound-guided ESPB has a good analgesic effect on patients with rib fractures; it can reduce postoperative nausea and vomiting, and can promote early postoperative outcomes．