目的 观察超声引导下竖脊肌平面阻滞(erector spinae plane,ESP)和硬膜外自控镇痛(patient controlled epidural analgesia, PCEA)对老年患者胸腔镜手术术后镇痛的影响。方法 选择医院胸外科2018-05至2019-05择期行胸腔镜手术的老年患者70例,男38例,女32例,年龄62~78岁,BMI 20.3~24.5 kg/m²,ASAⅠ级或Ⅱ级。采用随机数字表法分为ESP组和PCEA组,每组35例。两组均采用全身麻醉常规诱导、维持。ESP组在T₅水平行单次竖脊肌平面阻滞,超声确定竖脊肌平面后给予 0.5% 罗哌卡因 0.5 ml/kg, PCEA组于术前行硬膜外阻滞,给予试验剂量后,术中不予连续硬膜外阻滞,手术结束前30 min给予硬膜外吗啡负荷量,手术结束前行PCEA。记录患者术后1、4、12、24、48 h静息和咳嗽时VAS、舒适度(BCS)评分。比较两组患者对术后镇痛的满意度,头晕、咳嗽无力、胸闷等不良反应发生情况。结果 ESP组术后1、4、12、24 h静息和咳嗽时VAS及BCS评分,患者满意度评分,与 PCEA组比较差异均无统计学意义;但48 h VSA评分增高,BCS评分降低,差异均有统计学意义(P＜0.05);ESP组术后24~48 h追加曲马多患者增多,与 PCEA组比较差异有统计学意义(P＜0.05)。ESP组发生头晕、咳嗽无力、胸闷不良反应和头痛等并发症,明显少于PCEA组,差异有统计学意义(P＜0.05)。两组均未见气胸、局麻药中毒、内脏损伤等并发症。结论 超声引导下单次ESP对老年患者胸腔镜手术术后镇痛安全有效。

Objective To evaluate the effect of ultrasound-guided erector spine plane block and patient-controlled epidural analgesia on postoperative analgesia in elderly patients undergoing thoracoscopic surgery.Methods Seventy elderly patients (38 males and 32 females, aged 62 to 78, BMI 20.3-24.5 kg/m², ASA Ⅰ or Ⅱ) undergoing elective thoracoscopic surgery between May 2018 and May 2019 were enrolled. These patients were evenly divided into two groups: the ESP group and PCEA group using random number table method. In the ESP group, single spinal plane block was performed at the level of thoracic 5 (T₅). 0.5% ropivacaine 0.5 ml/kg was given after the erector plane was determined by ultrasound. In the PCEA group, epidural block was performed before and after the experimental dose was given. No continuous epidural block was given during surgical procedures. Morphine was epidurally injected at the loading dose 30 minutes before the end of operation and PCEA was used as postoperative analgesia. General anesthesia was routinely induced and maintained in both groups. VAS and BCS scores were recorded at 1, 4, 12, 24 and 48 h postoperatively. The scores of satisfaction of patients with postoperative analgesia were recorded. Such adverse reactions as dizziness, cough weakness and chest tightness and such complications as headache, pneumothorax, local anesthetic poisoning, visceral injury and general spinal anesthesia were recorded.Results Compared with the PCEA group, there was no significant difference in VAS scores or BCS score in the ESP group at postoperative 1, 4, 12, 24 hours. VSA scores increased while BCS scores decreased at postoperative 48 hours (P<0.05) and the number of patients who needed additional tramadol was increased (P<0.05). The incidence of dizziness, cough weakness, chest tightness and headache in the ESP group were lower than in the PCEA group (P<0.05). There was statistical difference in satisfaction scores between the two groups. No pneumothorax, local anesthetic poisoning, visceral injury, general spinal anesthesia or other related complications was recorded in either group.Conclusions Ultrasound-guided single spine plane block is safe and effective for postoperative analgesia in elderly patients undergoing thoracoscopic surgery.