摘要
目的评估超声引导下椎旁神经阻滞与局部浸润麻醉用于机器人辅助肾根治性切除手术对患者术后炎性细胞因子水平和恢复质量的影响。方法前瞻性选取2022年1~8月在中部战区总医院行择期机器人辅助腹腔镜肾根治性切除手术患者100例,采用随机数字表法将其分为观察组和对照组,每组各50例。观察组患者采用全身麻醉联合椎旁神经阻滞,对照组患者采用全身麻醉联合切口局部浸润麻醉,术后均连接静脉自控镇痛泵。记录两组患者术后静息和咳嗽时的疼痛视觉模拟量表(visual analogue scale,VAS)评分、系统性免疫炎性指数(systemic immune inflammatory index,SII)、白细胞介素-6(interleukin-6,IL-6)、术后15项恢复质量量表(QoR-15)评分,并记录两组患者瑞芬太尼用量、镇痛泵有效按压次数、补救镇痛次数、不良反应及相关并发症的发生情况。结果与对照组比较,观察组术后1、2天静息和咳嗽时疼痛VAS评分更低(P<0.05);术后1、3天时SII、IL-6更低(P<0.05);术后1、2、5天时的QoR-15评分更高(P<0.05);术中瑞芬太尼用量更少(P<0.01);镇痛泵有效按压次数更少(P<0.05);补救镇痛及不良反应发生率更低(P>0.05)。结论椎旁神经阻滞较局部浸润麻醉可为机器人辅助肾根治性切除手术提供更好的术中及术后镇痛效果,降低术后早期炎性反应,加速患者早期康复。
Objective To evaluate the effects of ultrasound-guided paravertebral nerve block(PVNB)and local infiltration anesthesia on postoperative inflammation level and recovery quality of patients after robot-assisted radical nephrectomy.Methods A total of 100 patients who underwent elective robot-assisted laparoscopic radical nephrectomy in General Hospital of Central Theater Command from January 2022 to August 2022 were selected prospectively.They were randomly divided into observation group and control group by random number table method,with 50 cases in each group.The observation group chose general anesthesia combined with PVNB,while the control group chose general anesthesia combined with incision local infiltration anesthesia.All patients were connected with patient-controlled intravenous analgesia(PCIA)after operation.The pain visual analogue scale(VAS)of rest and cough,the systemic immune inflammatory index(SII),interleukin-6(IL-6),and the QoR-15 scores of the patients after operation in the two groups were recorded.The dosage of remifentanil,the times of effective compression of analgesia pump and remedial analgesia were recorded in the two groups.Adverse reactions and related complications were recorded.Results Compared with the control group,the pain VAS of rest and cough in the observation group were lower on first and second day after operation(P<0.05).SII and IL-6 were lower on the first and third day after operation(P<0.05).The QoR-15 scores on the first,second,and fifth day after operation were higher(P<0.05).The dosage of remifentanil was less during operation(P<0.01).The effective pressing times of intravenous analgesia pump were less after operation(P<0.05).Lower incidence of remedial analgesia and adverse effects(P>0.05).Conclusion Compared with local infiltration anesthesia,PVNB can provide better intraoperative and postoperative analgesia effect,reduce the early postoperative inflammatory reaction and accelerate the early recovery of patients for robot-assisted radical nephrectomy.
作者
李月
殷国江
阮剑辉
宋晓阳
甘国胜
LI Yue;YIN Guojiang;RUAN Jianhui(The First School of Clinical Medicine,Southern Medical University,Guangdong 510515,China)
出处
《医学研究杂志》
2023年第11期113-117,共5页
Journal of Medical Research
基金
湖北省卫生和计划生育委员会联合基金项目(WJ2018H0082)。
