摘要
目的比较竖脊肌平面阻滞与切口浸润麻醉对全麻胸腔镜肺部分切除术患者术后早期恢复的影响。方法选取拟在全麻胸腔镜下行肺部分切除术患者80例,性别不限,年龄50~78岁,BMI 18~30 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=40):切口局部浸润组(D组)和竖脊肌平面阻滞组(E组)。E组在麻醉诱导完成,改为侧卧位后,在超声引导下行患侧竖脊肌平面阻滞,注射0.25%盐酸罗哌卡因30 ml;D组切皮前采用0.25%盐酸罗哌卡因行切口浸润麻醉。术后行自控静脉镇痛,当静态NRS评分>3分或咳嗽时NRS评分≥6分时,静脉注射氟比洛芬酯补救镇痛。分别于术前1 d和术后24、48 h时行QOR-15评分。分别于切皮前、术毕和术后24 h时,采用ELISA法测定血浆IL-6和IL-1β浓度。记录术中瑞芬太尼用量、术后48 h内镇痛泵有效按压次数、补救镇痛情况、术后首次下床活动时间、首次肛门排气时间、住院时间和术后48 h内恶心呕吐、肺部感染的发生情况。结果与D组比较,E组术后24和48 h时QOR-15评分升高,术中瑞芬太尼用量和镇痛泵有效按压次数减少,补救镇痛率降低,首次补救镇痛时间延长,术后首次肛门排气时间缩短(P<0.05)。2组间各时点血浆IL-6、IL-1β浓度、术后首次下床活动时间、住院时间和恶心呕吐、肺部感染发生率比较差异无统计学意义(P>0.05)。结论相对于切口浸润麻醉而言,竖脊肌平面阻滞用于全麻胸腔镜肺部分切除术,可减少术中阿片类药物用量,减轻术后疼痛,促进术后早期恢复。
Objective To compare the effects of transverse abdominis plane block and incision infiltration anesthesia on the early postoperative recovery in the patients undergoing thoracoscopic lung resection with general anesthesia.Methods Eighty American Society of Anesthesiologists Physical Status classificationⅡorⅢpatients,regardless of gender,aged 50-78 yr,with body mass index of 18-30 kg/m^(2),scheduled for elective thoracoscopic lung resection under general anesthesia,were divided into 2 groups(n=40 each)using a random number table method:incision local infiltration group(group D)and transverse abdominis plane block group(group E).In group E,the patients were changed to the lateral position after completion of anesthesia induction,ultrasound-guided transverse abdominis plane block was performed on the affected side,with 0.25%ropivacaine hydrochloride 30 ml injected.In group D,infiltration anesthesia with 0.25%ropivacaine hydrochloride was performed before incision.Postoperative patient-controlled intravenous analgesia was carried out,and flurbiprofen axetil was intravenously injected for rescue analgesia when the numerical rating scale score at rest>3 or numerical rating scale score≥6 while coughing.Quality of Recovery-15 scale scores were assessed at 1 day before surgery and 24 and 48 h after surgery.Plasma concentrations of interleukin-6(IL-6)and IL-1βwere measured by enzyme-linked immunosorbent assay before incision,at the end of surgery,and at 24 h after surgery.The amount of remifentanil used during surgery,the number of effective pressing times of patient-controlled analgesia within 48 h after surgery,requirement for rescue analgesia,first ambulation time after surgery,time to first flatus,length of hospital stay,and occurrence of nausea and vomiting and pulmonary infection within 48 h after surgery were recorded.Results Compared with group D,Quality of Recovery-15 scale scores were significantly increased,the amount of remifentanil used during surgery and the number of effective pressing times of patient-controlled analgesia were reduced,the rate of rescue analgesia was decreased,the time to first rescue analgesia was prolonged,and the time to first flatus was shortened in group E(P<0.05).There were no significant differences in the plasma concentrations of IL-6 and IL-1βat various time points,time to first ambulation after surgery,length of hospital stay,and incidence of nausea and vomiting and pulmonary infection between the two groups(P>0.05).Conclusions Compared with incision infiltration anesthesia,transverse abdominis plane block can reduce intraoperative consumption of opioids,alleviate postoperative pain,and promote early postoperative recovery when used for thoracoscopic lung resection under general anesthesia.
作者
张玲玲
王平
王志刚
陈永学
苑进革
Zhang Lingling;Wang Ping;Wang Zhigang;Chen Yongxue;Yuan Jinge(Department of Anesthesiology,Handan Central Hospital,Handan 056008,China;Graduate school of Hebei North University,Zhangjiakou 075000,China;Department of Anesthesiology,The Fourth Hospital of Shijiazhuang,Shijiazhuang 050000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2024年第2期167-171,共5页
Chinese Journal of Anesthesiology
作者简介
通信作者:苑进革,Email:yuanjinge@163.com。
