术前胸段椎旁阻滞对气管拔管期间苏醒期躁动的影响：一项随机对照试验
Effect of Preoperative Thoracic Paravertebral Blocks on Emergence Agitation During Tracheal Extubation: A Randomized Controlled Trial.
作者信息
Liu Wei, Luo Taijun, Wang Fei, Zhang Ding, Liu Tao, Huang Jiapeng, Xu Shaofa
机构信息
Department of Anesthesiology, Beijing Chest Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China.
出版信息
Front Med (Lausanne). 2022 Jun 22;9:902908. doi: 10.3389/fmed.2022.902908. eCollection 2022.
OBJECTIVE
This study aims to compare the effects of preoperative thoracic paravertebral blocks (TPVB) with intercoastal nerve blocks (ICNB) on emergence agitation (EA) during tracheal extubation in patients who underwent thoracoscopic lobectomy.
DESIGN SETTING AND PARTICIPANTS
A randomized clinical trial was conducted in patients undergoing thoracoscopic lobectomy at Beijing Chest Hospital between June 2019 and December 2020.
INTERVENTIONS
Patients were randomly assigned 1:1 to receive either ultrasound-guided preoperative TPVB or ICNB.
MAIN OUTCOMES AND MEASURES
The primary outcome was the occurrence of emergency agitation, which was evaluated by Aono's four-point scale (AFPS). Secondary outcomes included hemodynamics [mean arterial pressure (MAP) and heart rate (HR)]; and post-operative pain intensity [visual analog scale (VAS), Ramsay sedation score (RSS), and patient-controlled analgesia (PCA) demand times].
RESULTS
Among the 100 patients aged 55-75 years old, 50 were randomized to each group; 97 patients completed the trial. Compared to the ICNB group, the occurrence of EA in the TPVB group was significantly lower [31.3% (15/48) vs. 12.2% (6/49), relative risk = 1.276, 95% CI: 1.02-1.60, = 0.028]. For patients in the TPVB group, the MAP and HR at 5, 10, and 30 min after extubation were significantly lower; the intraoperative details including emergence time, extubation time, and consumption of sufentanil were significantly shorter than that in the ICNB group. Additionally, patients in the TPVB group showed significantly lower VAS at rest or coughing and significantly lower RSS at 60 and 240 min after extubation than patients in the ICNB group (all < 0.05).
CONCLUSION
Preoperative TPVB was associated with less EA during tracheal extubation when compared with ICNB in patients undergoing thoracoscopic lobectomy.
CLINICAL TRIAL REGISTRATION
[http://www.chictr.org.cn/index.aspx], identifier [ChiCTR1900023852].
目的
本研究旨在比较术前胸椎旁神经阻滞（TPVB）与肋间神经阻滞（ICNB）对接受胸腔镜肺叶切除术患者气管拔管期间苏醒期躁动（EA）的影响。
设计、地点和参与者：2019年6月至2020年12月期间，在北京胸科医院对接受胸腔镜肺叶切除术的患者进行了一项随机临床试验。
干预措施
患者按1:1随机分配，接受超声引导下的术前TPVB或ICNB。
主要结局和测量指标
主要结局是苏醒期躁动的发生情况，采用青野四点量表（AFPS）进行评估。次要结局包括血流动力学指标[平均动脉压（MAP）和心率（HR）]；以及术后疼痛强度[视觉模拟量表（VAS）、拉姆齐镇静评分（RSS）和患者自控镇痛（PCA）需求次数]。
结果
在100例年龄55 - 75岁的患者中，每组随机分配50例；97例患者完成试验。与ICNB组相比，TPVB组EA的发生率显著更低[31.3%（15/48）对12.2%（6/49），相对风险 = 1.276，95%CI：1.02 - 1.60，P = 0.028]。对于TPVB组的患者，拔管后5、10和30分钟时的MAP和HR显著更低；术中包括苏醒时间、拔管时间和舒芬太尼消耗量等细节显著短于ICNB组。此外，TPVB组患者在静息或咳嗽时的VAS显著更低，且拔管后60和240分钟时的RSS显著低于ICNB组患者（均P < 0.05）。
结论
与ICNB相比，术前TPVB与接受胸腔镜肺叶切除术患者气管拔管期间更少的EA相关。
临床试验注册
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