International Journal of Clinical Research
International Journal of Clinical Research. 2024; 8: (2) ; 10.12208/j.ijcr.20240048 .
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北京医院麻醉科 北京；国家老年医学中心 湖南长沙； 中国科学院老年医学研究所 北京
*通讯作者： 孙晓璐,单位：北京医院麻醉科 北京；国家老年医学中心 湖南长沙； 中国科学院老年医学研究所 北京；
心脏手术后的疼痛很常见，可以由直接的手术操作引起，也可由间接的炎症刺激引起。疼痛控制不佳还会导致围手术期应激激素释放、交感神经刺激，导致血液动力学变化和心肌耗氧量增加。充分的镇痛是确保患者舒适、低发病率、早期下地活动和降低成本的先决条件。研究发现阿片类药的使用与不良反应有关，并且减少阿片类药物的使用可能促进患者早期康复，因此多模式镇痛应运而生。然而基于药物组合的多模式镇痛也存在缺点，区域麻醉/镇痛是多模式镇痛的有效替代方案。近年来，随着超声技术的进步，加速了神经阻滞在心脏手术镇痛的发展，超声引导下神经阻滞可以实时观察穿刺针的行进过程、目标神经的详细结构、血管的有效规避、局麻药的扩散，具有突出的优势。本综述旨在介绍不同超声引导下神经阻滞方法在心脏手术镇痛中的应用，以期对心脏手术患者行更好的围术期疼痛管理。
Pain after cardiac surgery is common and can be caused by direct surgical procedures or indirect inflammatory stimuli. Poor pain control also leads to perioperative stress hormone release, sympathetic nerve stimulation, resulting in hemodynamic changes and increased myocardial oxygen consumption. Adequate analgesia is a prerequisite for ensuring patient comfort, low morbidity, early ground movement and reduced costs. Studies have found that opioid use is associated with adverse reactions, and that reducing opioid use may promote early recovery in patients, so multimodal analgesia was created. However, multi-modal analgesia based on drug combinations also has disadvantages, and regional anesthesia/analgesia is an effective alternative to multi-modal analgesia. In recent years, with the advancement of ultrasound technology, the development of nerve block in cardiac surgery analgesia has been accelerated. Under ultrasound guidance, nerve block can observe the process of puncture needle, the detailed structure of target nerve, the effective avoidance of blood vessels, and the diffusion of local anesthetics in real time, which has outstanding advantages. The purpose of this review is to introduce the application of different ultrasound-guided nerve block methods in cardiac surgery analgesia, in order to better perioperative pain management for cardiac surgery patients.
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