摘要
目的 探讨超声引导下竖脊肌平面阻滞(erector spinae plane block, ESPB)用于全身麻醉下同种异体肾移植手术的术后镇痛效果。方法 选取2021年8-12月首都医科大学宣武医院泌尿外科收治的因慢性肾功能不全行同种异体肾移植手术的患者60例,采用随机数字表法分为竖脊肌平面阻滞组(ESPB组)和对照组(C组),每组30例。ESPB组在全身麻醉诱导前采用0.5%罗哌卡因30 ml进行超声引导下术侧ESPB;C组不进行神经阻滞操作,术毕使用0.5%罗哌卡因30 ml行切口局部浸润。术后进行随访,比较两组术后静息时和活动时的疼痛水平,并记录两组术后恶心呕吐、胸闷等并发症发生率。结果 静息状态,ESPB组术后2h、4h和8h的疼痛评分均低于C组[3.0(2.2,4.0)分比4.0(3.0,6.0)分,3.0(2.0,3.0)分比3.0(3.0,5.0)分,2.0(1.0,3.0)分比3.0(2.0,3.0)分],差异有统计学意义(P<0.05);活动状态,ESPB组术后2h和4h的疼痛评分均低于C组[3.5(3.0,4.0)分比5.0(3.0,6.0)分,3.0(2.0,4.0)分比4.0(3.0,5.0)分],差异有统计学意义(P<0.05)。ESPB组术中丙泊酚用量少于C组[(4.02±0.78)mg/(kg·h)比(4.73±1.10)mg/(kg·h)],术后补救镇痛比例低于C组(43.3%比69.0%),差异均有统计学意义(P<0.05)。两组术后并发症发生率及住院时间比较,差异均无统计学意义(P>0.05),且ESPB组未见神经阻滞相关并发症。结论 术前行超声引导下ESPB可缓解肾移植手术患者的术后急性疼痛,且不增加术后并发症发生率。ESPB用于肾移植手术术后镇痛安全有效。
Objective To observe the postoperative analgesic effects of ultrasound-guided erector spinae plane block(ESPB) in allograft renal transplantation under general anesthesia. Methods A total of 60 patients with chronic renal failure underwent allograft renal transplantation in Department of Urology, Xuanwu Hospital, Capital Medical University from August to December 2021 were randomly divided into erector spinae plane block group(ESPB group, n = 30) and control group(C group, n = 30) by random number table. Patients in the ESPB group received 30 ml 0.5% ropivacaine for ultrasoundguided ESPB before anesthesia induction. Patients in the C group were not treated with fascial block and 30 ml 0.5%ropivacaine was used for incision local anesthesia at the end of surgery. Patients were followed up after surgery, the pain intensity at rest and activity were analyzed and compared between the two groups, and the incidence of postoperative nausea and vomiting, chest tightness and other complications in the two groups were recorded. Results At rest, the pain intensity at2 h [3.0(2.2, 4.0) points vs. 4.0(3.0, 6.0) points], 4 h [3.0(2.0, 3.0) points vs. 3.0(3.0, 5.0) points] and 8 h [2.0(1.0, 3.0)points vs. 3.0(2.0, 3.0) points] in the ESPB group were lower than those in the C group, and the differences were statistically significant(P < 0.05). At activity, the pain intensity at 2 h [3.5(3.0, 4.0) points vs. 5.0(3.0, 6.0) points] and 4 h [3.0(2.0, 4.0)points vs. 4.0(3.0, 5.0) points] in ESPB group were lower than those in the C group, and statistical significance was found between the two groups(P < 0.05). The dosage of propofol in ESPB group was lower than that in C group [(4.02 ± 0.78)mg/(kg · h)vs.(4.73 ± 1.10) mg/(kg · h)], and the proportion of rescue analgesia in ESPB group was lower than that in C group(43.3% vs. 69.0%), the difference between the two groups was statistically significant(P < 0.05). There were no significant differences in the incidence of postoperative complications and length of hospital stay between t
作者
安奕
赵磊
王天龙
李丽霞
李中嘉
梁传玉
王沛
An Yi;Zhao Lei;Wang Tianlong;Li Lixia;Li Zhongjia;Liang Chuanyu;Wang Pei(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《北京医学》
CAS
2022年第7期590-594,598,共6页
Beijing Medical Journal
基金
宣武医院国家自然科学基金青年培育项目(QNPY2020027)
国家重点研发计划数字诊疗装备研发重点专项2018年度非定向项目(2018YFC0116700)
北京市属医学科研院所公益发展改革试点项目(京医研2019-2)。
关键词
竖脊肌平面阻滞
肾移植
术后镇痛
术后并发症
erector spinae plane block(ESPB)
renal transplantation
postoperative analgesia
postoperative complication
