胸肋筋膜阻滞对非体外循环冠状动脉旁路移植术老年患者术后疲劳的影响：一项随机临床试验。

Impact of pecto-intercostal fascial block on postoperative fatigue in elderly patients undergoing off-pump coronary artery bypass grafting: a randomized clinical trial.

作者信息

Wang Xinghe, Zhou Meiyan, Liu Qian, Shen Fangming, Zhang Zhe, Wang Long, Qi Yu, Sun Jia, Wang Liwei

机构信息

Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China.

Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China.

出版信息

Int J Surg. 2025 May 1;111(5):3323-3330. doi: 10.1097/JS9.0000000000002353.

DOI:10.1097/JS9.0000000000002353

PMID:40146244

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12165496/

Abstract

BACKGROUND

Postoperative fatigue syndrome (POFS) is a common yet often under-recognized consequence of surgical interventions, particularly in cardiac surgery. POFS is associated with prolonged recovery times, extended hospital stays, and increased healthcare costs. Current strategies for preventing POFS have demonstrated limited success. This study aims to evaluate the impact of pecto-intercostal fascial block (PIFB) on the incidence of POFS in elderly patients undergoing off-pump coronary artery bypass graft (CABG) surgery.

METHODS

In this randomized controlled trial, 110 elderly patients scheduled for off-pump CABG surgery were randomly assigned to either the PIFB group ( n = 55; 0.4% ropivacaine) or the control group ( n = 55; normal saline). The primary outcome was the incidence of POFS, which was assessed using the ICFS-10 scale. Secondary outcomes included postoperative pain scores, opioid consumption, extubation time, duration of ICU and hospital stay, and Quality of Recovery (QoR-15) scores.

RESULTS

The incidence of POFS was significantly lower in the PIFB group compared to the control group on postoperative days 1 (69.0% vs. 92.7%, P = 0.004), 3 (63.6% vs. 83.6%, P = 0.030), and 5 (52.7% vs. 72.7%, P = 0.048), with no significant differences observed by day 7 and 8 weeks. Pain scores were also markedly lower in the PIFB group at three time points: immediately after extubation, 12 hours post-surgery, and 24 hours post-surgery ( P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, opioid consumption was reduced by an average of 11.1 mg ( P < 0.001). Patients in the PIFB group experienced significantly shorter extubation times (5.5 ± 1.8 hours vs. 8.6 ± 2.1 hours, P < 0.001), ICU stays (31.8 ± 7.3 hours vs. 39.4 ± 7.5 hours, P < 0.001), and hospital stays (8.2 ± 1.1 days vs. 8.8 ± 1.2 days, P = 0.007). QoR-15 scores were significantly higher in the PIFB group on postoperative days 1, 3, and 5 ( P < 0.001, P = 0.003, and P = 0.037, respectively). Notably, no PIFB-related adverse events were reported in either group.

CONCLUSIONS

PIFB significantly alleviated early POFS, enhanced pain management, reduced opioid consumption, and accelerated recovery, thereby improving the overall quality of recovery in elderly patients undergoing off-pump CABG.

摘要

背景

术后疲劳综合征（POFS）是手术干预常见但常未被充分认识的后果，尤其是在心脏手术中。POFS与恢复时间延长、住院时间延长及医疗费用增加相关。目前预防POFS的策略成效有限。本研究旨在评估胸肋筋膜阻滞（PIFB）对接受非体外循环冠状动脉旁路移植术（CABG）的老年患者POFS发生率的影响。

方法

在这项随机对照试验中，110例计划行非体外循环CABG手术的老年患者被随机分为PIFB组（n = 55；0.4%罗哌卡因）或对照组（n = 55；生理盐水）。主要结局是POFS的发生率，采用ICFS - 10量表进行评估。次要结局包括术后疼痛评分、阿片类药物消耗量、拔管时间、重症监护病房（ICU）和住院时间以及恢复质量（QoR - 15）评分。

结果

与对照组相比，PIFB组在术后第1天（69.0%对92.7%，P = 0.004）、第3天（63.6%对83.6%，P = 0.030）和第5天（52.7%对72.7%，P = 0.048）POFS的发生率显著更低，在第7天和8周时未观察到显著差异。在三个时间点，即拔管后即刻、术后12小时和术后24小时，PIFB组的疼痛评分也显著更低（分别为P < 0.001、P < 0.001和P = 0.002）。此外，阿片类药物消耗量平均减少11.1 mg（P < 0.001）。PIFB组患者的拔管时间显著更短（5.5 ± 1.8小时对8.6 ± 2.1小时，P < 0.001）、ICU住院时间（31.8 ± 7.3小时对39.4 ± 7.5小时，P < 0.001）和住院时间（8.2 ± 1.1天对8.8 ± 1.2天，P = 0.007）。PIFB组在术后第1天、第3天和第5天的QoR - 15评分显著更高（分别为P < 0.001、P = 0.003和P = 0.037）。值得注意的是，两组均未报告与PIFB相关的不良事件。