摘要
目的观察超声引导下单次竖脊肌平面阻滞(erector spinae plane block,ESPB)联合静脉镇痛用于肝叶切除术患者的效果。方法择期肝叶切除术患者90例,男63例,女27例,年龄30~65岁,BMI 20~29 kg/m2, ASAⅠ或Ⅱ级,随机分为三组:单次ESPB联合静脉镇痛组(EP组)、硬膜外镇痛组(EA组)、单纯自控静脉镇痛组(IA组),每组30例。三组患者均采用全身麻醉。EP组于麻醉诱导前行0.33%罗哌卡因30 ml+地塞米松5 mg单次ESPB。EA组患者于麻醉诱导前行T10~11间隙穿刺置入硬膜外导管,术毕硬膜外镇痛。EP组和IA组术毕使用静脉镇痛泵。记录ESPB的阻滞平面和术后2、6、12、24和48 h的静息和咳嗽时VAS评分;记录镇痛泵按压次数、追加曲马多例数;记录皮肤瘙痒、恶心呕吐、尿潴留、胸闷等不良反应发生情况和ESPB相关并发症;记录患者对术后镇痛的满意度评分。结果 EP组痛觉阻滞范围,T5—T12脊神经支配区域16例,T4—T11脊神经支配区域11例,T6—L1脊神经支配区域3例。术后2、6、12、24和48 h EP组和EA组静息和咳嗽时VAS评分明显低于IA组(P<0.05)。EP组和EA组镇痛泵按压次数和追加曲马多例数明显少于IA组(P<0.05)。三组均未出现呼吸抑制不良反应。EP组术后恶心呕吐发生率明显低于IA组(P<0.05),EA组皮肤瘙痒和尿潴留发生率明显高于IA组(P<0.05)。EP组和EA组患者对术后镇痛效果的总体满意度评分明显高于IA组(P<0.05)。结论超声引导下竖脊肌平面阻滞联合患者自控静脉镇痛技术用于肝叶切除术后镇痛能够获得硬膜外镇痛的效果,且不良反应发生率低,患者满意度更高。
Objective To observe the effect of ultrasound-guided erector spinae plane block(ESPB) compound with patient controlled intravenous analgesia on postoperative analgesia in patients undergoing hepatic lobectomy surgery. Methods Ninety patients undergoing hepatic lobectomy surgery, 63 males and 27 females, aged 30-65 years, BMI 20-29 kg/m2, ASA Ⅰ or Ⅱ, were randomly divided into three groups: erector spinae plane block compound with patient controlled intravenous analgesia(group EP), epidural analgesia group(group EA)and intravenous analgesia group(group IA), 30 cases in each group. ESPB had been finished at group EP and epidural approach have been work out at group EA with 0.33% ropivacaine 30 ml and dexamethasone 5 mg before the anesthesia induction, all groups of patients undergoing general anesthesia. The block range of ESPB, VAS score were recorded at postoperative 2, 6, 12, 24 and 48 h. The number of analgesia pump pressure, number of tramadol medication, adverse reactions(nausea and vomiting, itchy skin, uroschesis, chest tightness) cases and complications related to the ESPB, patient’s satisfaction on postoperative analgesia were also recorded. Results The range of pain block in group EP included 16 cases of spinal innervation area(T5-T12), 11 cases of spinal innervation area(T4-T11) and 3 cases of spinal innervation area(T6-L1). Postoperative VAS scores of group EP and group EA at 2, 6, 12, 24 and 48 h after surgery were significantly lower than those of group IA at rest and coughing(P < 0.05). The number of compressions with analgesic pump and supplemental tramadol in group EP and group EA were significantly less than group IA(P < 0.05). Adverse respiratory reaction was not found in the three groups. The incidence of postoperative nausea and vomiting in group EP was significantly lower than that in group IA(P < 0.05), and the incidence of pruritus and urinary retention in group EA was significantly higher than that in group IA(P < 0.05). The overall satisfaction scores of group EP and group EA on pos
作者
周桥灵
刘洪珍
伍辉萍
廖美娟
赖晓红
贺俭
欧伟明
王汉兵
ZHOU Qiaoling;LIU Hongzhen;WU Huiping;LIAO Meijuan;LAI Xiaohong;HE Jian;OU Weiming;WANG Hanbing(Department of Anaesthesia, the Affiliated Foshan Hospital of Sun Yat-sen University, Foshan 528000, China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2019年第7期635-639,共5页
Journal of Clinical Anesthesiology
基金
广东省临床重点专科建设资金资助项目[粤卫(2011)144]
佛山市医学类科技攻关项目(2015AB00301)
关键词
竖脊肌平面阻滞
肝叶切除术
术后镇痛
Erector spinae plane block
Hepatic lobectomy surgery
Postoperative analgesia
