摘要
目的通过与腹横肌平面(TAP)阻滞比较,评价超声引导竖脊肌平面阻滞(ESPB)在腹腔镜全子宫切除术围术期的镇痛效果。方法选取120例行择期腹腔镜全子宫切除术患者,按随机数字表法分为TAP组、ESPB组和对照组,每组40例。常规全身麻醉后,TAP组行TAP阻滞、ESPB组行ESPB,对照组不给予任何神经阻滞。3组患者术后均给予自控静脉镇痛(PCIA)。记录3组患者术中丙泊酚、瑞芬太尼用量及苏醒时间;术后24h内PCIA有效按压次数及舒芬太尼用量;采用视觉模拟评分(VAS)比较术后2~48h各时点静息及咳嗽时疼痛评分;随访术后不良反应及早期康复指标。结果与对照组比较,TAP组和ESPB组术中丙泊酚、瑞芬太尼用量明显减少(P<0.05),苏醒时间、术后首次肛门排气时间、下床时间、术后住院时间均明显缩短(均P<0.05),PCIA有效按压次数及舒芬太尼用量减少,镇痛补救率及恶心、呕吐发生率均降低(均P<0.05),术后2~24h各时点静息及咳嗽时VAS评分均明显降低(均P<0.05)。TAP组和ESPB组上述指标比较差异均无统计学意义(均P>0.05)。结论超声引导ESPB能为腹腔镜全子宫切除术患者提供安全有效的围术期镇痛,与TAP阻滞的效果相当,能促进患者早期康复。
Objective To evaluate the efficacy of erector spinae plane block(ESPB)for the patients undergoing laparoscopic total hysterectomy by comparing with transversus abdominis plane(TAP)block.Methods One hundred and twenty patients undergoing elective laparoscopic total hysterectomy were randomly assigned into TAP group,ESPB group and control group with 40 cases in each group.Patients in TAP and ESPB groups were received ultrasound-guided TAP or ESPB with respectively,while the control group was received routine general anesthesia only.Patient-controlled intravenous analgesia(PCIA)was performed in all patients postoperatively.Postoperative recovery time,the total dosage of propofol and remifentanil were recorded during surgery.The press times of PCIA and the cumulative dosage of sufentanil was recorded at 24h after surgery.At 2,4,8,12,24,48h after surgery,the VAS pain score at rest and coughing were evaluated.Postoperative rehabilitation indicators and adverse effects were also recorded.Results Compared with control group,the total dosage of propofol and remifentanil was significantly decreased in TAP and ESPB groups(P<0.05).The postoperative recovery time,the time of first anal exhaust,ambulation and hospitalization after surgery in TAP and ESPB groups were significantly shorter than those in control group(P<0.05).The press times of PCIA and the cumulative dosage of sufentanil in TAP and ESPB groups were also reduced within 24 hours after surgery(P<0.05).Requirement for rescue analgesic and incidence of nausea and vomiting were decreased in TAP and ESPB groups(P<0.05).The VAS scores in TAP and ESPB groups were significantly lower than that in control group(P<0.05),whereas,no significant difference between TAP and ESPB groups(P>0.05).Conclusion Compared with TAP,ESPB can provide effective and safe analgesia for patients undergoing laparoscopic hysterectomy,with equivalent performances in analgesia,which is beneficial to the recovery of patients.
作者
金晓伟
王和节
蒋毅
JIN Xiaowei;WANG Hejie;JIANG Yi(Department of Anesthesiology,Wenzhou Integrated Traditional Chinese and Western Medicine Hospital,Wenzhou 325000,China)
出处
《浙江医学》
CAS
2020年第12期1310-1313,1317,共5页
Zhejiang Medical Journal
基金
温州市科技计划基础性医疗卫生科技项目(Y20180566)。
作者简介
通信作者:蒋毅,E-mail:13868361202@163.com。
