超声引导前路胸膜外间隙阻滞在机器人辅助胸腔镜肺手术中的应用

doi:10.3969/j.issn.1006-5725.2026.04.012

Abstract

Abstract:

Objective To evaluate the perioperative analgesic efficacy of ultrasound-guided anterior extrapleural space block in patients undergoing robot-assisted thoracoscopic lung surgery. Methods A total of 64 patients scheduled for elective robot-assisted thoracoscopic lung surgery between January 2024 and March 2025 were randomly assigned to two groups： the anterior extrapleural space block combined with general anesthesia group （Group A， n = 32） and the general anesthesia-alone group （Group G， n = 32）. The following parameters were recorded： mean arterial pressure （MAP） and heart rate （HR） at baseline （T₀， upon entering the operating room）， after anesthesia induction （T₁）， at skin incision （T₂）， at the start of lung resection （T₃）， at the end of surgery （T₄）， and upon leaving the operating room （T₅）. Intraoperative consumption of anesthetic， time to first postoperative opioid analgesic requirement， Visual Analog Scale （VAS） scores at 12 h， 24 h， and 48 h postoperatively， anesthesia recovery time， operating room exit time， postoperative hospital stay， and adverse events were also documented. Results At the T₂ to T₅ time points， Group A exhibited lower MAP and HR values in comparison with Group G （P < 0.05）. Group A required substantially smaller dosages of ciprofol and remifentanil during the surgical procedure compared with Group G （P < 0.05）. The time to first postoperative opioid analgesia in Group A was longer than that in Group G （P < 0.05）. The VAS scores for rest and coughing in Group A were lower than those in Group G at 12 h， 24 h， and 48 h following surgery （P < 0.05）. Group A exhibited shorter anesthesia recovery time， shorter time to leave the operating room， and reduced postoperative hospital stay compared to Group G（P < 0.05）， with a lower overall incidence of adverse reactions （P < 0.05）. Conclusion Ultrasound-guided anterior extrapleural space block delivers effective perioperative analgesia in robot-assisted thoracoscopic lung surgery， reduces intraoperative anesthetic requirements， decreases postoperative opioid demand， and facilitates recovery.

Key words: ultrasound-guided, extrapleural space, nerve block, robot-assisted, lung surgery

CLC Number:

R614

Guojiang YIN,Wei HUANG,Jiaojiao GUI,Wenjie WANG,Sijia WANG,Xiaoyang SONG,Bixi LI. Application of ultrasound⁃guided anterior extrapleural space block in robot⁃assisted thoracoscopic lung surgery[J]. The Journal of Practical Medicine, 2026, 42(4): 626-632.

Figures/Tables 7

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References 25

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指标	A组（n = 32）	G组（n = 32）	χ²/t值	P值
ASA 分级/例			0.474	0.789
Ⅰ级	2	3
Ⅱ级	28	26
Ⅲ级	2	3
性别/例			0.063	0.802
男	17	16
女	15	16
年龄/岁	53.22 ± 10.98	52.97 ± 12.23	0.086	0.932
体质量/kg	64.13 ± 9.88	63.69 ± 10.41	0.172	0.864
身高/cm	164.66 ± 7.33	165.31 ± 8.32	-0.335	0.739
BMI/（kg/m²）	23.54 ± 2.31	23.19 ± 2.54	0.576	0.567
麻醉时间/min	273.25 ± 86.87	275.56 ± 88.39	-0.106	0.916
手术时间/min	214.59 ± 84.42	215.13 ± 83.04	-0.025	0.980
左/右肺手术/例	14/18	13/19	0.064	0.800
手术方法/例			1.232	0.745
肺楔形切除术	13	12	0.066	0.798
肺段切除术	13	12	0.066	0.798
肺癌根治术	4	7	0.988	0.320
袖状肺叶切除术	2	1	0.350	0.554

指标	组别	例数	T₀	T₁	T₂	T₃	T₄	T₅
MAP/mmHg	A组	32	103.19 ± 12.33	86.84 ± 8.30	87.22 ± 8.64^?	87.16 ± 8.99^?	92.19 ± 9.64^?	93.22 ± 9.61^?
	G组	32	103.81 ± 11.21	86.81 ± 7.10	94.06 ± 7.64	94.28 ± 7.48	98.22 ± 8.65	98.75 ± 9.39
	F_时间/P_时间		62.100/< 0.001
	F_{时间组间}/P_{时间组间}		7.900/< 0.001
	F_组间/P_组间		4.498/0.038
HR/（次/min）	A组	32	75.53 ± 10.28	63.59 ± 8.10	63.88 ± 8.26^?	63.88 ± 7.65^?	67.53 ± 7.35^?	68.66 ± 7.03^?
	G组	32	75.31 ± 9.24	63.19 ± 7.08	68.25 ± 6.90	68.63 ± 7.97	74.59 ± 8.43	75.31 ± 8.76
	F_时间/P_时间		35.077/< 0.001
	F_{时间组间}/P_{时间组间}		6.569/< 0.001
	F_组间/P_组间		4.646/0.035

组别	例数	环泊酚	瑞芬太尼
A组	32	230.31 ± 79.70	2.86 ± 1.17
G组	32	293.44 ± 101.59	5.12 ± 1.69
t值		-2.766	-6.226
P值		0.007	< 0.001

指标	组别	例数	术后12 h	术后24 h	术后48 h
静息VAS	A组	32	0.50（0.00，1.00）	3.00（2.00，3.00）	2.00（1.25，3.00）
	G组	32	5.00（3.00，5.00）	4.00（3.00，5.00）	3.00（2.00，3.00）
	Z值		-6.030	-4.107	-2.048
	P值		< 0.001	< 0.001	0.041
咳嗽VSA	A组	32	1.00（0.00，2.00）	4.00（3.00，5.00）	3.00（2.25，4.00）
	G组	32	6.00（5.00，7.00）	5.00（4.00，7.00）	4.00（3.00，4.00）
	Z值		-5.935	-3.728	-2.007
	P值		< 0.001	< 0.001	0.045

组别	例数	麻醉苏醒时间/min	出手术室时间/min	术后住院时间/d	总不良反应/［例（%）］
A组	32	12.84 ± 8.02	52.28 ± 10.51	7.69 ± 1.35	2（6.25）
G组	32	18.53 ± 9.71	61.13 ± 14.83	9.69 ± 3.35	8（25.00）
t/χ²值		-2.555	-2.753	-3.135	4.267
P值		0.013	0.008	0.003	0.039

Application of ultrasound⁃guided anterior extrapleural space block in robot⁃assisted thoracoscopic lung surgery

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