摘要
目的探讨超声引导下腹横筋膜平面(TFP)阻滞在髂嵴前部取骨移植术的应用效果。方法选择行髂嵴前部取骨移植术患者59例,男32例,女27例,年龄18~64岁,BMI 18~24 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为两组:超声引导下TFP阻滞联合全麻组(T组,n=30)和常规全麻组(G组,n=29)。T组行超声引导下术侧TFP阻滞,G组不进行TFP阻滞。记录麻醉诱导前1 min、手术开始后1、10、30、60 min和手术结束时的HR、MAP和呼出气七氟醚浓度(C_(ET)Sev)、术中芬太尼、瑞芬太尼和丙泊酚用量、拔管时间、PACU停留时间。记录术后4、8、12、24、48 h髂骨供区的静息和活动时VAS疼痛评分。记录PCIA总按压次数、有效按压次数、曲马多补救镇痛用量、补救镇痛和患者对髂骨供区镇痛的满意情况。结果与G组比较,手术开始后1、10、30 min T组HR明显减慢、MAP明显降低(P<0.05),手术开始后1 min至手术结束时T组C_(ET)Sev明显降低(P<0.05);T组术中芬太尼、瑞芬太尼和丙泊酚用量明显减少(P<0.05),拔管时间和PACU停留时间明显缩短(P<0.05);T组术后4、8、12 h的静息和活动时VAS疼痛评分、术后PCIA总按压次数、有效按压次数、曲马多补救镇痛用量明显减少(P<0.05)、补救镇痛率明显降低(P<0.05),患者对髂骨供区镇痛满意率明显升高(P<0.05)。结论超声引导下TFP阻滞用于髂嵴前部取骨移植术麻醉和镇痛效果较好,有利于减少围术期麻醉镇痛药用量,血流动力学平稳,恢复快速,安全性高,患者满意度高。
Objective To investigate the effect of ultrasound-guided transversalis fascia plane(TFP)block in anterior iliac crest bone graft harvesting.Methods Fifty-nine patients undergoing anterior iliac crest bone graft harvesting were selected,32 males and 27 females,aged 18-64 years,BMI 18-24 kg/m^(2),ASA physical statusⅠorⅡ.Patients were randomly divided into two groups:ultrasound-guided transversalis fascia plane block combined with general anesthesia group(group T,n=30)and conventional general anesthesia group(group G,n=29).Patients in group T received ultrasound-guided TFP block,while patients in group G did not receive TFP block.HR,MAP and exhaled concentration of sevoflurane(C_(ET)Sev)at 1 minute before anesthesia induction,1 minute,10,30,60 minutes after skin incision,the end of surgery,the duration of the procedure and anaesthesia,the consumption of fentanyl,remifentanil and propofol during the procedure,extubation time,PACU stay time of two groups were recorded.Postoperative pain at iliac bone donor site were assessed using visual analog scale(VAS)pain score at rest and during exercise 4,8,12,24 hours after the surgery.Total compression times,effective compression times of PCIA and the consumption of tramadol,and the rate of remedial analgesia were recorded.Patients satisfaction with analgesia for iliac bone donor site was accessed.Results Compared with group G,HR slowed down significantly and MAP decreased significantly at 1 minute,10,30 minutes after skin incision in group T(P<0.05),and C_(ET)Sev were significantly lower from 1 minute after skin incision to the end of the surgery in group T(P<0.05),the consumption of fentanyl,remifentanil and propofol during the procedure in group T were significantly reduced(P<0.05),extubation time and PACU stay time were also significantly shortened(P<0.05),VAS pain scores at rest and during exercise 4,8 and 12 hours after the surgery in group T were significantly lower(P<0.05),the total and effective compression times of PCIA,the consumption of tramadol,and the rate of
作者
赵丽艳
康定坤
于国军
陈可新
王艳
袁哲
孙芳芳
ZHAO Liyan;KANG Dingkun;YU Guojun;CHEN Kexin;WANG Yan;YUAN Zhe;SUN Fangfang(Department of Anesthesiology,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang 471000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2023年第10期1055-1059,共5页
Journal of Clinical Anesthesiology
关键词
超声引导
腹横筋膜平面阻滞
髂嵴前部
骨移植
全身麻醉
镇痛
Ultrasound-guided
Transversalis fascia plane block
Anterior iliac crest
Bone graft harvesting
General anesthesia
Analgesia
