摘要
目的:探讨超声引导椎旁神经阻滞联合全麻在腹腔镜胆囊切除术患者中的应用效果及对VAS评分的影响。方法:选择2018年1-12月在本院治疗的腹腔镜胆囊切除术患者60例作为对象,按照随机数字表法将其分为对照组(n=30)和观察组(n=30)。对照组给予全身麻醉,观察组在对照组基础上联合超声引导椎旁神经阻滞。统计并记录两组术后首次排气时间、丙泊酚、瑞芬太尼用量;统计两组入室后(T0)、切皮前(T1)、气腹3 min后(T2)、胆囊剥离时(T4)的HR、MAP、SpO2变化情况;采用直观模拟量表(VAS)量表对两组术后0、1、6、12、24 h疼痛进行评估;统计并记录两组术后恶心、呕吐、尿潴留、寒战、嗜睡发生率。结果:两组术后首次排气时间比较,差异无统计学意义(P>0.05);观察组丙泊酚、瑞芬太尼用量均少于对照组(P<0.05)。T1、T2及T3时,对照组HR、MAP均高于T0及观察组,SaO2均低于T0及观察组,差异均有统计学意义(P<0.05),但观察组HR、MAP、SpO2与T0时比较,差异均无统计学意义(P>0.05)。观察组术后0、1、6、12、24 h VAS评分均低于对照组(P<0.05);两组恶心、呕吐、尿潴留、寒战、嗜睡发生率比较,差异均无统计学意义(P>0.05)。结论:超声引导椎旁神经阻滞联合全麻用于腹腔镜胆囊切除术患者中手术创伤较小,对生命体征影响较小,能减轻围术期疼痛,并发症发生率较低,值得推广应用。
Objective:To investigate the effect of ultrasound-guided paravertebral nerve block combined with general anesthesia in patients undergoing laparoscopic cholecystectomy and its influence on VAS score.Method:Sixty patients with laparoscopic cholecystectomy treated in our hospital from January to December 2018 were enrolled.They were divided into the control group(n=30)and the observation group(n=30)according to the random number table.The control group was given general anesthesia,and the observation group combined with ultrasound-guided paravertebral nerve block on the basis of the control group.The first exhaust time,Propofol and Remifentanil dosage of two groups were recorded.The changes of HR,MAP and SpO2 in two groups after entering the room(T0),before the incision(T1),3 minutes after the pneumoperitoneum(T2)and at the time of gallbladder dissection(T3)were counted.The visual analogue scale(VAS)was used to evaluate the pain at 0,1,6,18,and 24 hours after operation.The incidence of postoperative nausea,vomiting,urinary retention,chills,and lethargy of two groups were recorded and compared.Result:There was no significant difference in the first exhaust time between two groups(P>0.05).The doses of Propofol and Remifentanil in the observation group were lower than those in the control group(P<0.05).At T1,T2 and T3,HR and MAP in the control group were higher than those in T0 and the observation group,and SpO2 were lower than those in T0 and the observation group,the differences were statistically significant(P<0.05);however,HR,MAP,SpO2 and of the observation group were compared with T0,the differences were not statistically significant(P>0.05).The VAS scores at 0,1,6,12 and 24 hours after operation in the observation group were lower than those in the control group(P<0.05).There were no significant differences in incidence of nausea,vomiting,urinary retention,chills and drowsiness between the two groups(P>0.05).Conclusion:Ultrasound-guided paravertebral nerve block combined with general anesthesia for laparoscopic cholecystectomy has less surgical trauma,less impact on patients’vital signs,can reduce perioperative pain,and has a lower incidence of complications,it is worthy of pop ularization and application.
作者
何志权
关宇健
陈家华
HE Zhiquan;GUAN Yujian;CHEN Jiahua(Binhaiwan Central Hospital of Dongguan City,Dongguan 523000,China)
出处
《中国医学创新》
CAS
2020年第9期36-40,共5页
Medical Innovation of China
基金
2018年东莞市社会科技发展(一般)项目(2018507150251319)。
关键词
超声引导
椎旁神经阻滞
全身麻醉
腹腔镜胆囊切除术
生命体征
VAS
评分
并发症
Ultrasound-guided
Paravertebral nerve block
General anesthesia
Laparoscopic cholecystectomy
Vital signs
VAS score
Complications
作者简介
通信作者:何志权。
