超声引导竖脊肌平面阻滞用于肺结节术前CT引导定位的随机对照试验
单中心前瞻性随机对照试验纳入82例接受术前CT引导肺结节定位的患者，比较超声引导竖脊肌平面阻滞（ESPB）联合局部麻醉与单纯局部麻醉的镇痛效果与安全性。结果显示ESPB组胸膜穿透时NRS评分、术前焦虑、辐射暴露、透视时间及气胸发生率均显著降低，患者满意度更高。
要点
- ESPB可显著降低胸膜穿透时疼痛评分（2.68±1.52 vs 5.17±1.32）。
- ESPB减少辐射暴露、透视时间及气胸发生率（4.88% vs 19.51%）。
- ESPB提高术后舒适度与患者满意度。
核心结论
- 超声引导ESPB可改善CT引导肺结节定位的镇痛效果，减少焦虑、辐射暴露和并发症，提高患者满意度。
研究设计与样本
- 单中心前瞻性随机对照试验，2024年6月至2025年1月纳入82例接受术前CT引导肺结节定位的患者。
- 对照组采用4 ml 1%利多卡因局部麻醉，ESPB组采用超声引导下20 ml 0.375%罗哌卡因ESPB联合局部麻醉。
主要发现
- ESPB组胸膜穿透时NRS评分显著低于对照组（2.68±1.52 vs 5.17±1.32）。
- ESPB组术前焦虑评分低于对照组（44.71±3.45 vs 50.63±3.74）。
- ESPB组辐射暴露低于对照组（401.06±266.01 vs 875.36±377.45 mGy*cm）。
- ESPB组透视时间短于对照组（55.10±10.54 vs 117.39±20.68 s）。
- ESPB组气胸发生率低于对照组（4.88% vs 19.51%），所有P < 0.05。
关键数值与推荐
- 主要结局为胸膜穿透时NRS评分，ESPB组2.68±1.52 vs 对照组5.17±1.32。
- 气胸发生率ESPB组4.88% vs 对照组19.51%，P < 0.05。
临床怎么用
- 对于接受CT引导肺结节定位的患者，可考虑联合超声引导ESPB以改善镇痛并降低气胸风险。
局限性
- 单中心研究，样本量82例，结论外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
J Cardiothorac Surg. 2026 Apr 24;21(1):369. doi: 10.1186/s13019-026-04235-1. ABSTRACT BACKGROUND: The increasing detection of pulmonary nodules through low-dose computed tomography screening has necessitated precise preoperative localization techniques. While local anesthesia is routinely used for CT-guided pulmonary nodule localization, it inadequately addresses deep tissue pain during pleural penetration. This study is to evaluate the analgesic efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) during CT-guided pulmonary nodule localization. METHODS: This single-center, prospective, randomized controlled trial was conducted from June 2024 to January 2025, enrolling 82 patients undergoing preoperative CT-guided pulmonary nodule localization. Participants were randomly assigned to either control group (local anesthesia with 4 ml 1% lidocaine) or ESPB group (ultrasound-guided ESPB with 20 ml 0.375% ropivacaine plus local anesthesia). The primary outcome was numerical rating scale (NRS) score during pleural penetration. Secondary outcomes included anxiety levels, radiation exposure, procedural time, hemodynamic parameters, pneumothorax incidence, and patient satisfaction. Statistical analysis was performed using independent-sample t-test and Mann-Whitney U test. RESULTS: The ESPB group demonstrated significantly lower NRS scores during pleural penetration compared to the control group (2.68 ± 1.52 vs. 5.17 ± 1.32). Patients receiving ESPB exhibited reduced preoperative anxiety (44.71 ± 3.45 vs. 50.63 ± 3.74), decreased radiation exposure (401.06 ± 266.01 vs. 875.36 ± 377.45 mGy*cm), shorter fluoroscopy time (55.10 ± 10.54 vs. 117.39 ± 20.68 s, ), and lower pneumothorax incidence (4.88% vs. 19.51%), all P < 0.05. Post-procedural comfort scores and patient satisfaction were significantly higher in the ESPB group. CONCLUSIONS: Ultrasound-guided ESPB improves analgesia, reduces anxiety, radiation exposure and complications while enhancing patient satisfaction during CT-guided pulmonary nodule localization, representing a valuable adjunct for thoracic interventional procedures. TRIAL REGISTRATION: ClinicalTrials.gov NCT06441071, registered May 8, 2024. PMID: 42032730 | PMC: PMC13251217 | DOI: 10.1186/s13019-026-04235-1
引用
- PubMed 高证据 · 肺结节与肺癌筛查：Effect of ultrasound-guided erector spinae plane block for preoperative CT-guided percutaneous localization of pulmonary nodules: a randomized controlled trial
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。