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罗哌卡因胸横肌平面阻滞联合胸肋间筋膜阻滞在正中胸骨切开术镇痛中的临床研究
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| 篇名： | 罗哌卡因胸横肌平面阻滞联合胸肋间筋膜阻滞在正中胸骨切开术镇痛中的临床研究 |
| TITLE： | A clinical study of ropivacaine in transversus thoracis muscle plane block combined with pecto-intercostal fascial plane block for analgesia in median sternotomy |
| 摘要： | 目的 探讨罗哌卡因胸横肌平面阻滞联合胸肋间筋膜阻滞用于正中胸骨切开术镇痛的效果及安全性。方法将2025年12月－2026年4月于恩施土家族苗族自治州中心医院行正中胸骨切开术的患者70例，随机分为胸横肌平面阻滞（T）组与胸横肌平面阻滞联合胸肋间筋膜阻滞（TP）组，每组35例。两组患者均使用0.3%罗哌卡因40mL，分别在超声引导下行双侧胸横肌平面阻滞或双侧胸横肌平面阻滞+胸肋间筋膜阻滞。比较两组患者术后48h内舒芬太尼总用量、镇痛指标（术中舒芬太尼总用量、首次按压镇痛泵时间、镇痛泵有效按压次数）、康复指标（术后拔管时间、ICU滞留时间、首次排气时间、术后引流管拔除时间、总住院天数）、循环指标（不同时间点的心率和平均动脉压）、术后疼痛评分[不同时间点的静息和运动视觉模拟评分量表（VAS）评分]和不良反应（恶心呕吐、CO2蓄积、谵妄、呼吸道感染）发生率。结果两组各有1例患者退出研究。TP组患者术后48h内舒芬太尼总用量、所有镇痛指标和康复指标水平以及静息和运动VAS评分均显著优于T组（P＜0.05）；两组患者循环指标水平及大部分不良反应发生率比较，差异均无统计学意义（P＞0.05），但TP组患者术后CO2蓄积发生率显著低于T组（P＜0.05）。结论与单纯胸横肌平面阻滞相比，罗哌卡因用于胸横肌平面阻滞联合胸肋间筋膜阻滞可为行正中胸骨切开术的患者提供有效的镇痛效果，促进患者早期康复，且安全性良好。 |
| ABSTRACT： | OBJECTIVE To investigate the efficacy and safety of ropivacaine in transversus thoracis muscle plane block （TTMP） combined with pecto-intercostal fascial plane block （PIFB） for postoperative analgesia in median sternotomy.METHODS A total of 70 patients who underwent median sternotomy at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture， from December 2025 to April 2026 were enrolled and randomly divided into the TTMP group （group T， n ＝35） and the TTMP combined with PIFB group （group TP， n ＝35）. Both groups received 40 mL of 0.3% ropivacaine under ultrasound guidance. group TP received bilateral TTMP combined with PIFB， while group T received bilateral TTMP alone. The total consumption of sufentanil within 48 hours postoperatively， analgesic indicators （intraoperative total sufentanil consumption， time to first patient-controlled analgesia pump press， number of effective analgesia pump presses）， recovery indicators （postoperative extubation time， length of ICU stay， time to first flatus， time to postoperative drainage tube removal， total length of hospital stay）， circulatory indicators （heart rate and mean arterial pressure at different time points）， postoperative pain scores [Visual Analog Scale （VAS） scores at rest and during movement at different time points]， and the incidence of adverse reactions （nausea and vomiting， CO 2 retention， delirium， respiratory tract infection） were compared between the two groups.RESULTS One patient in each group withdrew from the study. The total consumption of sufentanil within 48 hours postoperatively， all analgesic indicators， all recovery indicators， and VAS scores at rest and during movement in group TP were significantly better than those in group T （ P ＜0.05）. There were no statistically significant differences in circulatory indicators or the incidence of most adverse reactions between the two groups （ P ＞0.05）， but the incidence of postoperative CO 2 retention in group TP was significantly lower than that in group T （ P ＜0.05）.CONCLUSIONS Compared with TTMP alone， ropivacaine in TTMP combined with PIFB provides effective analgesia， promotes early recovery， and has good safety in patients undergoing median sternotomy. |
| 期刊： | 2026年第37卷第19期 |
| 作者： | 何祥麟；朱贤林；杨敏；崔芝红 |
| AUTHORS： | HE Xianglin，ZHU Xianlin，YANG Min，CUI Zhihong |
| 关键字： | 罗哌卡因;正中胸骨切开术;胸横肌平面阻滞;胸肋间筋膜阻滞;联合阻滞;镇痛 |
| KEYWORDS： | Ropivacaine;median sternotomy;transversus thoracis muscle plane block;pecto-intercostal fascial plane block;combined block;Analgesia |
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