先天性心脏手术胸腔切开术中的区域麻醉与全身镇痛：四级护理儿童医院的回顾性病例系列
Regional Anesthesia Versus Systemic Analgesia in Thoracotomies for Congenital Cardiac Surgery: A Retrospective Case Series in a Quaternary Care Children's Hospital.
摘要(中文译文)
背景/目的：有限的研究描述了在先天性心脏手术开胸术中，区域麻醉技术联合全身镇痛与单纯全身镇痛在术后结局方面的差异。本回顾性病例系列旨在评估区域麻醉技术在接受心脏手术开胸术的儿童中改善术后结局的疗效，并与仅接受全身镇痛而未接受任何区域麻醉的儿童进行比较。方法：收集2017年1月至2022年3月期间在一家单中心四级护理儿童医院因主动脉缩窄或血管环修复而接受开胸术的18岁以下患者的围手术期数据，包括是否使用区域或椎管内麻醉技术。收集的主要结局为术后24小时疼痛评分和24小时阿片类药物消耗量。收集的次要结局为中度疼痛发生率、拔管时间和阻滞并发症。结果：研究期间共有140例患者因主动脉缩窄或血管环接受开胸术。62例（44.3%）使用了区域或椎管内麻醉（椎旁阻滞、竖脊肌平面阻滞、前锯肌阻滞或尾部阿片类药物）。椎旁阻滞是最常见的阻滞方式。两组在最初24小时内均表现出良好的疼痛控制。区域阻滞组与非区域阻滞组的24小时阿片类药物消耗量（静脉注射吗啡等效剂量（IME）的mg/kg）相似（0.36（0.20，0.54）对0.39（0.18，0.62）；p=0.48）。两组间中度疼痛发生率无统计学显著差异。结论：接受区域麻醉联合全身镇痛的患者以及仅接受全身镇痛的患者疼痛均得到良好控制，两组患者群体在疼痛评分、中度疼痛或阿片类药物使用方面均无差异。
Abstract
Background/objectives Limited studies have characterized differences in postoperative outcomes between regional anesthetic techniques with systemic analgesia and systemic analgesia alone in thoracotomies for congenital cardiac surgery. This retrospective case series aimed to assess the efficacy of regional anesthetic techniques in improving postoperative outcomes in children undergoing thoracotomies for cardiac surgery in comparison to children who only received systemic analgesia without any regional anesthesia. Methods Perioperative data from patients under 18 years of age who underwent thoracotomy for coarctation of the aorta or vascular ring repair between January 2017 and March 2022 in a single-center quaternary care children's hospital were collected, including the presence or absence of a regional or neuraxial anesthetic technique. Primary outcomes collected were 24-hour postoperative pain scores and 24-hour opioid consumption. Secondary outcomes collected were incidence of moderate pain, time to extubation, and block complications. Results One hundred and forty patients underwent thoracotomy for coarctation or vascular ring in the study period. Regional or neuraxial anesthesia (paravertebral, erector spinae plane, serratus anterior, or caudal opioid) was utilized in 62 (44.3%) cases. Paravertebral blocks were the most common block. Both groups demonstrated well-controlled pain throughout the first 24 hours. Twenty-four-hour opioid consumption (mg/kg of intravenous morphine equivalents (IME)) was similar between regional and non-regional groups (0.36 (0.20, 0.54) versus 0.39 (0.18, 0.62); p=0.48). There was no statistically significant difference in the incidence of moderate pain between groups. Conclusions Pain was well-controlled in patients who received regional plus systemic analgesia as well as patients who received systemic analgesia alone, with no differences in pain scores, moderate pain, or opioid use between the patient populations.
如何引用
AMA
Michael A Evans, Lav Patel, Sara Izzo, Santhanam Suresh, David J Krodel. Regional Anesthesia Versus Systemic Analgesia in Thoracotomies for Congenital Cardiac Surgery: A Retrospective Case Series in a Quaternary Care Children's Hospital.. Cureus. 2026; doi:10.7759/cureus.107126.
APA
Michael A Evans, Lav Patel, Sara Izzo, Santhanam Suresh, David J Krodel (2026). Regional Anesthesia Versus Systemic Analgesia in Thoracotomies for Congenital Cardiac Surgery: A Retrospective Case Series in a Quaternary Care Children's Hospital.. Cureus. https://doi.org/10.7759/cureus.107126
GB/T 7714
Michael A Evans, Lav Patel, Sara Izzo, Santhanam Suresh, David J Krodel. Regional Anesthesia Versus Systemic Analgesia in Thoracotomies for Congenital Cardiac Surgery: A Retrospective Case Series in a Quaternary Care Children's Hospital.[J]. Cureus, 2026 doi:10.7759/cureus.107126.
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