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超声引导下 SAPB 及 TPVB 在肋骨骨折术后镇痛效果中的对比分析
Comparative Analysis of the Analgesic Effect of Ultrasound-guided SAPB and TPVB in Alleviating Pain after Rib Fracture Surgery

李永辉.超声引导下 SAPB 及 TPVB 在肋骨骨折术后镇痛效果中的对比分析[J].中国烧伤创疡杂志,2021,(3):207~210.

DOI：

英文关键词:Ultrasound-guided Multiple rib fractures Serratus anterior plane block(SAPB) Thoracic paravertebral block(TPVB) Analgesia

基金项目:

作者	单位
李永辉	郑州市第三人民医院麻醉科

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中文摘要:

【摘要】目的对比分析超声引导下前锯肌平面阻滞(SAPB)与胸椎旁神经阻滞(TPVB)对肋骨骨折术后患者的镇痛效果? 方法选取 2018 年1月至2020 年1月郑州市第三人民医院收治的 80 例拟行肋骨骨折手术的患者作为研究对象, 按照随机数表法将其随机分为 SAPB 组和 TPVB 组, 每组 40 例, SAPB 组患者术后采用超声引导下 SAPB 镇痛, TPVB 组患者术后采用超声引导下TPVB镇痛, 对比两组患者气管导管拔出30 min(T1 )、术后 12 h(T2)、术后 24 h(T3)、术后 36 h(T4) 时静息状态与咳嗽状态的疼痛视觉模拟评分法(VAS) 评分、Ramsay 镇静评分以及恶心呕吐、血肿、气胸等不良反应发生情况? 结果 SAPB 组患者术后 12 h 静息状态和咳嗽状态 VAS 评分均明显低于TPVB 组(t = 4. 258、 6. 265, P 均 < 0. 001), 而术后 36 h 静息状态和咳嗽状态 VAS 评分均明显高于 TPVB 组( t = 4. 082、 5. 618, P 均 < 0.001);两组患者各时间段镇静评分均无明显差异( t = 0. 437、0. 520、0. 906、0. 518，P =0.663、0.604、0.367、0.605); SAPB组患者总不良反应发生率为 7. 5% , 与 TPVB 组患者总不良反应发生率 15.0% 相比,无明显差异( χ 2 = 1.127, P = 0.288)? 结论与超声引导下 TPVB相比, 超声引导下 SAPB 在肋骨骨折术后12 h 内具有良好的镇痛效果, 且操作相对简便, 具有较高的临床应用价值?

英文摘要:

【Abstract】Objective To analyze and compare the effect of ultrasound-guided serratus anterior plane block(SAPB) and thoracic paravertebral block(TPVB) in alleviating pain after rib fracture surgery. Methods Eighty patients with rib fractures, admitted to the Third People's Hospital of Zhengzhou City from January 2018 to January 2020 for rib fracture surgery, were selected as research subjects, and divided, according to the random number table, into SAPB group and TPVB group, with 40 cases in each group. Patients in the SAPB group were given ultrasound-guided SAPB for pain relief after surgery, whereas patients in the TPVB group were given ultrasound-guided TPVB. The following factors were compared between the two groups including visual analogue scale(VAS) score of pain and Ramsay sedation score during the rest and coughing states at 30 min(T1) after the removal of tracheal tube and 12 h(T2) , 24 h(T3) and 36 h after surgery(T4), and adverse reactions such as nausea and vomiting, hematoma, pneumothorax. Results The VAS scores of patients during the rest and coughing states at 12 h after surgery in the SAPB group were significantly lower than that in the TPVB group(t=4.258, 6.265, P <0.001), whereas the VAS scores during the rest and coughing states at 36 h after surgery were significantly higher(t=4.082, 5.618, P <0.001). No significant difference was observed between the two groups in terms of sedation scores at each of the four time points(t=0.437, 0.520, 0.906 and 0.518, P=0.663, 0.604, 0.367 and 0.605). The total adverse reaction rate of patients was 7.5% in the SAPB group and 15.0% in the TPVB group, between which there was no significant difference(χ2=1.127, P=0.288). Conclusion Compared with the ultrasound-guided TPVB, ultrasound-guided SAPB can bring better analgesic effect for patients within 12 hours after rib fracture surgery. Moreover, the procedure is relatively easy to operate, presenting a high value of clinical application.