摘要
目的观察超声引导下前锯肌平面复合腹直肌鞘阻滞用于全身麻醉(简称全麻)下肝内胆管切开取石联合病变肝叶切除术的术后镇痛效果。方法选择2018年1月—2019年9月在佛山市第一人民医院择期行全麻下肝内胆管切开取石联合病变肝叶切除术患者60例,男54例、女6例,年龄范围40~70岁,BMI范围20~24 kg/m 2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为3组,每组20例:前锯肌平面阻滞+腹直肌鞘阻滞+硬膜外镇痛组(SAPB+RSB+PCIA组)、自控硬膜外镇痛组(PCEA组)和自控静脉镇痛组(PCIA组)。SAPB+RSB+PCIA组患者行超声引导下低位SAPB+双侧RSB,低位SAPB使用0.25%罗哌卡因30 mL+0.5%地塞米松0.5 mL,双侧RSB每侧使用0.25%罗哌卡因15 mL+0.5%地塞米松0.25 mL。PCEA组患者于T 10至T 11间隙穿刺置管,予2%利多卡因3 mL作为试验剂量,5 min后测试麻醉平面和效果,以排除全脊髓麻醉和局部麻醉药中毒。PCIA组不作任何处理。SAPB+RSB+PCIA组和PCIA组两组术毕前30 min均使用舒芬太尼2μg/kg行PCIA。3组采取分次静脉注射舒芬太尼5μg行补救镇痛,维持术后48 h内疼痛VAS评分≤3分。记录术后48 h内舒芬太尼补救镇痛用量,记录患者术后恶心呕吐、头晕、呼吸抑制、皮肤瘙痒和尿潴留等不良反应的发生情况。结果SAPB+RSB+PCIA组和PCEA组术后48 h内舒芬太尼的用量均显著少于PCIA组(P值均<0.05)。SAPB+RSB+PCIA组术后恶心呕吐、头晕和呼吸抑制的发生率均显著低于PCIA组(P值均<0.05),PCEA组的皮肤瘙痒和尿潴留的发生率均显著高于PCIA组(P值均<0.05)。结论超声引导SAPB+RSB用于全麻下肝内胆管切口取石联合病变肝叶切除术患者的术后镇痛,镇痛效果好,可减少阿片类药物的使用量,且不良反应发生率低,有利于患者的快速康复。
Objective To observe postoperative analgesic effect of ultrasound-guided serratus anterior plane block(SAPB)combined with rectus abdominis sheath block(RSB)in patients undergoing intrahepatic cholangiotomy plus liver lobectomy under general anesthesia.Methods Sixty patients,BMI 20-24 kg/m 2,ASA physical status I or II,who underwent intrahepatic cholangiotomy plus liver lobectomy under general anesthesia in Foshan First People’s Hospital from January 2018 to September 2019 were enrolled in this study.There were 54 males and 6 females,aged 40-70 years.The patients were randomly divided into three groups(n=20):patient-controlled epidural analgesia(PCEA)group,patient-controlled intravenous analgesia(PCIA)group and SAPB+RSB+PCIA group.The patients in SAPB+RSB+PCIA group underwent ultrasound-guided low SAPB and bilateral RSB.0.25%ropivacaine(30 mL)+0.5%dexamethasone(0.5 mL)were used for low SAPB,and ropivacaine(0.25%,15 mL)+dexamethasone(0.5%,0.25 mL)were used for unilateral RSB.In PCEA group,catheterization was performed between T 10 and T 11,and 2%lidocaine(3 mL)was used as the test dose.The anesthesia level and effect were tested to exclude total spinal anesthesia and local anesthetic poisoning 5 min later.PCIA group received no treatment.Sufentanil 2μg/kg was given in SAPB+RSB+PCIA group and PCIA group 30 min post operation for PCIA.Moreover,sufentanil 5μg was intravenous injected for rescue analgesia in the three groups,and the visual analogue scale(VAS)score maintained≤3 within 48 hours after operation.The use of sufentanil for postoperative analgesia was recorded at 48 h after operation.The adverse reactions such as nausea,vomiting,dizziness,respiratory depression,pruritus and urinary retention were also recorded.Results The dosage of sufentanil in SAPB+RSB+PCIA group and PCEA group within 48 h after operation was significantly lower than that in PCIA group(all P<0.05).The incidence of postoperative nausea,vomiting,dizziness and respiratory depression in SAPB+RSB+PCIA group was significantly lower than tha
作者
赖晓红
杨承祥
刘洪珍
梁桦
周桥灵
LAI Xiaohong;YANG Chengxiang;LIU Hongzhen;LIANG Hua;ZHOU Qiaoling(Department of Anesthesiology,The First People's Hospital of Foshan,Foshan 528000,Guangdong,China)
出处
《上海医学》
CAS
2021年第4期242-245,共4页
Shanghai Medical Journal
关键词
神经传导阻滞
肝内胆管切开术
肝叶切除术
疼痛
前锯肌平面阻滞
术后疼痛
Nerve block
Intrahepatic cholangiotomy
Lobectomy,liver
Pain
Serratus anterior plane block
Rectus abdominis sheath block
Postoperative analgesia
