检索历史 清除

目的:评价超声引导竖脊肌平面阻滞联合全身麻醉对漏斗胸患儿Nuss术的优化效果。方法:择期拟行Nuss术漏斗胸患儿108例，性别不限，年龄7～18岁，BMI均在正常范围内，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为3组( n＝36)：超声引导竖脊肌平面阻滞(ESPB)联合全身麻醉组(E组)、胸段硬膜外镇痛(TEA)联合全身麻醉(T组)和全身麻醉组(G组)。E组和T组患儿于麻醉诱导后分别接受超声引导双侧ESPB[注射0.3 %罗哌卡因，双侧总量0.5 ml/kg(最大量20 ml)]或TEA[注射0.3%罗哌卡因0.5 ml/kg(最大量20 ml)]，3组均行全身麻醉，静脉注射丙泊酚2～3 mg/kg、舒芬太尼0.3～0.5 μg/kg和顺式阿曲库铵0.1～0.2 mg/kg麻醉诱导气管插管后行机械通气，静脉输注丙泊酚6～10 mg·kg －1·h －1和瑞芬太尼0.1～0.3 μg·kg －1·min －1维持麻醉。术后3组均行舒芬太尼PCIA。记录术中瑞芬太尼用量、术后各时段舒芬太尼PCIA用量、术后首次补救镇痛时间、布洛芬用量和术后并发症的发生情况。 结果:与G组相比，E组和T组术中瑞芬太尼用量和术后各时段舒芬太尼PCIA用量降低，首次补救镇痛时间延长，布洛芬用量减少( P<0.05)。3组术后并发症发生率比较差异无统计学意义( P>0.05)。 结论:ESPB联合全身麻醉有助于减轻漏斗胸患儿Nuss术后痛觉过敏。

Objective:To evaluate the optimization effect of ultrasound-guided erector spinae plane block (ESPB)combined with general anesthesia on Nuss procedure in pediatric patients with pectus excavatum undergoing Nuss procedure.Methods:One hundred and eight pediatric patients of either sex, aged 7-18 yr, with body mass index within the normal range, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, undergoing elective Nuss procedure, were randomized into 3 groups ( n=36 each) using a random number table method: ultrasound-guided ESPB combined with general anesthesia group (group E), thoracic epidural anesthesia plus general analgesia group (group T), and general analgesia group (group G). Pediatric patients received ultrasound-guided bilateral ESPB (0.3% ropivacaine was injected, 0.5 ml/kg bilateral total volume [maximum 20 ml]) or thoracic epidural anesthesia (0.3% ropivacaine 0.5 ml/kg [maximum 20 ml/side]) after induction of anesthesia in group E and group T, respectively. All the three groups underwent general anesthesia, anesthesia was induced with propofol 2-3 mg/kg, sufentanil 0.3-0.5 μg/kg and cis-atracurium 0.1-0.2 mg/kg and maintained with propofol 6-10 mg·kg -1·h -1 and remifentanil 0.1-0.3 μg·kg -1·min -1. The patients were endotracheally intubated and mechanically ventilated after anesthesia induction. The parent-controlled intravenous analgesia (PCIA) was used for patients in all the three groups postoperatively. The consumption of intraoperative remifentanil and postoperative consumption of sufentanil for PCIA in each period after surgery were recorded. The time to the first rescue analgesia, consumption of ibuprofen and postoperative complications were also recorded. Results:Compared with group G, the intraoperative consumption of remifentanil and postoperative consumption of sufentanil for PCIA in each period were significantly decreased, the time to the first rescue analgesia was prolonged, and the consumption of ibuprofen was decreased in group E ( P<0.05). There was no significant difference among the three groups ( P>0.05). Conclusions:ESPB combined with general analgesia is helpful in reducing postoperative hyperalgesia in pediatric patients undergoing the Nuss procedure.