摘要
目的比较超声引导下竖脊肌平面阻滞(ESPB)与腹横肌平面阻滞(TAPB)在腹腔镜下肝叶切除术术后的镇静镇痛效果。方法选取2019年1月至2021年3月西安交通大学第一附属医院收治的拟行腹腔镜下肝叶切除术的患者86例,按照麻醉方法不同分为对照组和观察组,各43例。对照组予以超声引导下TAPB,注入20 ml 0.25%罗哌卡因;观察组予以超声引导下ESPB,注入30 ml 0.25%罗哌卡因+5 mg地塞米松。比较两组患者术后康复指标(下床活动时间、术后苏醒时间、首次肛门排气时间及住院时间),术后拔管时、术后6 h、术后12 h、术后24 h、术后48 h的疼痛视觉模拟评分法(VAS)和Ramsay评分,统计并观察两组镇痛泵按压次数、追加曲马多比例以及不良反应发生情况。结果两组患者术后下床活动时间、术后苏醒时间、首次肛门排气时间及住院时间比较差异均无统计学意义(P>0.05)。咳嗽状态下VAS评分组间和时点间的主效应差异有统计学意义(P<0.01),但组间和时点间不存在交互作用(P>0.05),观察组术后拔管时、术后6 h的咳嗽状态VAS评分低于对照组(P<0.05);静息状态VAS评分、Ramsay评分时点间的主效应差异有统计学意义(P<0.01),但组间主效应差异无统计学意义(P>0.05),且组间和时点间均不存在交互作用(P>0.05),两组间术后不同时点间的静息状态VAS评分和Ramsay评分比较差异无统计学意义(P>0.05)。观察组患者48 h内按压镇痛泵次数少于对照组[(11.1±4.3)次比(13.2±4.4)次](P<0.05),追加曲马多比例低于对照组[4.65%(2/43)比18.60%(8/43)](P<0.05)。两组总不良反应发生率比较差异无统计学意义(P>0.05)。结论超声引导下ESPB与TAPB应用于腹腔镜下肝叶切除术患者术后均能获得较好的镇痛镇静效果,且不良反应发生率较低,与TAPB比较,ESPB镇痛药物用量更少,临床可根据患者具体情况选择麻醉方案。
Objective To compare sedative and analgesic effects of ultrasound-guided erector spinae plane block(ESPB)and transversus abdominis plane block(TAPB)after laparoscopic hepatic lobectomy.Methods A total of 86 patients undergoing laparoscopic hepatic lobectomy admitted to the First Affiliated Hospital of Xi′an Jiaotong University from Jan.2019 to Mar.2021 were included and divided into a control group and an observation group according to different anesthesia methods,with 43 cases in each group.The control group was given ultrasound-guided TAPB,injected with 20 ml of 0.25%ropivacaine;the observation group was given ultrasound-guided ESPB,injected with 30 ml of 0.25%ropivacaine+5 mg dexamethasone.The postoperative rehabilitation indicators(postoperative ambulation time,postoperative recovery time,first anal exhaust time,and hospitalization time)were compared between the two groups,as well as the visual analogue scale(VAS)and Ramsay score of pain at the time point of extubation after operation 6 h after operation,12 h after operation,24 h after operation,and 48 h after operation;the analgesic pump pressing times,the added tramadol proportion,and the occurrence of adverse reactions in the two groups were counted and observed.Results There was no significant difference in the postoperative ambulation time,postoperative recovery time,first anal exhaust time and hospitalization time between the two groups(P>0.05).The main effect difference of VAS score between groups and time points under cough state was statistically significant(P<0.01),but there was no interaction between groups and time points(P>0.05).The VAS scores of coughing state at postoperative extubation and 6 h after operation of the observation group were lower than those of the control group(P<0.05);the main effect differences of the resting state VAS score and Ramsay score between time points were statistically significant(P<0.01),but the main effect difference between the groups was not significant(P>0.05),and there was no interaction between groups and time points(P>0.05).There was no significant difference in the resting state VAS score and Ramsay score between the two groups at different time points after operation(P>0.05).The number of times of pressing the analgesic pump within 48 hours in the observation group was less than that in the control group[(11.1±4.3)times vs(13.2±4.4)times](P<0.05),and the proportion of added tramadol was lower than that in the control group[4.65%(2/43)vs 18.60%(8/43)](P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided ESPB and TAPB can both achieve good analgesic and sedative effects after laparoscopic hepatic lobectomy,and the incidence of adverse reactions is lower.Compared with TAPB,the dosage of analgesic drugs used in ESPB is less,and clinical anesthesia options can be selected according to the specific situation of the patient.
作者
刘庆波
周荣胜
汪博
LIU Qingbo;ZHOU Rongsheng;WANG Bo(Department of Anesthesia and Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)
出处
《医学综述》
CAS
2022年第11期2260-2265,共6页
Medical Recapitulate
基金
陕西省重点研发计划项目(2019SF-154)。
关键词
腹腔镜下肝叶切除术
术后镇静
超声引导下竖脊肌平面阻滞
腹横肌平面阻滞
Laparoscopic hepatic lobectomy
Postoperative sedation
Ultrasound-guided erector spinal plane block
Transversus abdominis plane block
作者简介
通信作者:周荣胜,Email:zhrs1981@163.com。
