超声引导下前锯肌平面神经阻滞在小儿漏斗胸NUSS手术中应用的临床疗效分析

Clinical Efficacy Analysis of Ultrasound-Guided Anterior Serratus Planar Nerve Block in Pediatric Funnel Chest NUSS Surgery

摘要: 目的：比较前锯肌平面神经阻滞、肋间神经阻滞术在小儿漏斗胸NUSS术中应用的效果。方法：选取2017~01月至2023~01月行NUSS术治疗漏斗胸患者117例，随机抽取行前锯肌平面阻滞、肋间神经阻滞、未给予神经阻滞的患者，每组人数相同。A组行前锯肌平面神经阻滞，B组行肋间神经阻滞，C组不给予神经阻滞，由医师判断术后给予镇痛药物。三组均采用气管插管–全麻，术中静–吸复合麻醉维持，术后均由医师判断给予镇痛药物。记录术后4 h (T₁)、8 h (T₂)、12 h (T₃)、24 h (T₄)脸谱疼痛评分法(FLACC)分数，术后镇痛药物使用频次，术后初次下床活动时间，住院时间长短，患者是否出现并发症(气胸，肺部感染，肺不张，胸腔积液，皮下血肿，驼背，脊柱侧弯)和不良反应(头晕，呕吐，精神差)及其发生率和严重程度等方面来评价前锯肌平面神经阻滞与肋间神经阻滞的差异与优劣。结果：FLACC评分T₁、T₄时p > 0.05，无统计学差异；T₂、T₃时，均A < B < C (p < 0.05)，比较有统计学差异；初次下床活动时间A < C，B < C (p < 0.05)；住院时间长短A、B < C组；并发症发生数B < A < C，不良反应发生数A < B < C。结论：前锯肌平面神经阻滞镇痛效果较好，术后住院时间相对更短，初次下床活动时间更早。

Abstract: Objective: Comparison of Anterior Serratus Plane Nerve Block and Intercostal Nerve Block in Pedi-atric Funnel Chest NUSS. Methods: One hundred and seventeen patients who underwent NUSS to treat funnel chest from 2017-01 to 2023-01 were selected, and patients who underwent anterior serratus plane nerve block, intercostal nerve block, and those who received no nerve block were randomly selected with the same number of patients in each group. In group A, anterior serratus plane nerve block was performed, in group B, intercostal nerve block was performed, and in group C, no nerve block was performed, and analgesics were administered in the postoperative period at the discretion of the physician. All three groups used tracheal intubation - general anesthesia, in-traoperative static - suction compound anesthesia maintenance; postoperative analgesics were given by the judgment of the physician. The postoperative 4 h (T₁), 8 h (T₂), 12 h (T₃) and 24 h (T₄) scores on the Facial Pain Assessment Scale (FLACC) were recorded, as well as the frequency of post-operative analgesic medication, the time of first postoperative movement out of bed, the length of hospital stay, and complications (pneumothorax, pulmonary infection, pulmonary atelectasis, pleu-ral effusion, subcutaneous hematoma, hunchback, scoliosis) and adverse reactions (dizziness, vom-iting, poor mental state) and their incidence and duration of stay, and poor mood, and their inci-dence and severity to evaluate the differences and advantages and disadvantages of anterior ser-ratus plane nerve block versus intercostal nerve block. Results: FLACC score at T₁ and T₄ p > 0.05, no statistical difference; at T₂ and T₃, both A < B < C (p < 0.05), there is a statistical difference in comparison; the time of the first time to get out of bed activities A < C, B < C (p < 0.05); length of hospitalization A, B < C group; the number of complications B < A < C, the number of adverse reac-tions A < B < C. Conclusions: The anterior serratus nerve block was more effective in providing an-algesia, with a relatively shorter postoperative hospital stay and earlier first time out of bed.