摘要
目的:探讨不同浓度罗哌卡因在膈神经阻滞中的临床效果分析。方法:选择2022年1月—2023年5月于宜昌市中心人民医院行腹腔镜下行全子宫切除术的180例患者,采用随机数字表法将纳入患者分为六组:A组(0.125%罗哌卡因,n=30)、B组(0.25%罗哌卡因,n=30)、C组(0.375%罗哌卡因,n=30)、D组(0.5%罗哌卡因,n=30)、E组(0.75%罗哌卡因,n=30)和对照组(不行膈神经阻滞,n=30),其中A~E组患者均于术前行超声引导下右侧膈神经阻滞。评估各组患者术后肩痛视觉模拟量表(VAS)评分、膈肌运动幅度(DM)、术后恢复及不良反应发生情况。结果:在术后肩痛方面,C组[(2.47±1.14)分vs (4.03±1.77)分]、D组[(2.53±1.22)分vs (4.03±1.77)分]、E组[(2.50±1.22)分vs (4.03±1.77)分]患者VAS评分明显低于对照组(均P<0.05);在DM方面,D组、E组患者膈神经阻滞10 min的DM明显低于对照组(均P<0.05);在麻醉恢复时间方面,D组[(22.50±2.16) min vs (20.73±1.76) min]和E组[(22.80±2.63) min vs (20.73±1.76) min]患者的PACU停留时间较对照组明显延长(均P<0.05);在患者术后恢复质量方面,C组、D组、E组患者术后24 h的15项恢复质量(QoR-15)评分明显高于对照组(均P<0.05);E组患者总不良反应发生率明显高于对照组(43.33%vs 16.67%)。结论:采用0.375%罗哌卡因行右侧膈神经阻滞是安全有效的,能有效减轻腹腔镜全子宫切除患者术后肩痛并提高术后恢复质量,且不会影响膈肌功能恢复及PACU停留时间,值得临床推广应用。
Objective:To explore the clinical effect of different concentrations of ropivacaine in phrenic nerve block.Methods:A total of 180 patients who underwent laparoscopic total hysterectomy at Yichang Central People's Hospital from January 2022 to May 2023 were selected and divided into six groups using a random number table method:group A(0.125%ropivacaine,n=30),group B(0.25%ropivacaine,n=30),group C(0.375%ropivacaine,n=30),group D(0.5%ropivacaine,n=30),group E(0.75%ropivacaine,n=30),and the control group(no phrenic nerve block,n=30).Among them,patients in groups A to E underwent ultrasound-guided right phrenic nerve block before surgery.The visual analog scale(VAS)score for shoulder pain,diaphragmatic movement amplitude(DM),postoperative recovery,and adverse reactions were evaluated in each group.Results:In terms of postoperative shoulder pain,the VAS scores in groups C(2.47±1.14 vs 4.03±1.77),D(2.53±1.22 vs 4.03±1.77),and E(2.50±1.22 vs 4.03±1.77)were significantly lower than those in the control group(all P<0.05).In terms of DM,the patients in groups D and E after 10 min of phrenic nerve block was significantly lower than that in the control group(both P<0.05).In terms of anesthesia recovery time,the PACU stay time of patients in groups D[(22.50±2.16)min vs(20.73±1.76)min]and E[(22.80±2.63)min vs(20.73±1.76)min]was significantly longer than that in the control group(both P<0.05).In terms of postoperative recovery quality,the 15-item quality of recovery(QoR-15)scores at 24 h after surgery in groups C,D,and E were significantly higher than those in the control group(all P<0.05).The incidence of total adverse reactions in group E was significantly higher than that in the control group(43.33%vs 16.67%).Conclusion:The use of 0.375%ropivacaine for right phrenic nerve block is safe and effective,which can effectively reduce postoperative shoulder pain and improve postoperative recovery quality in patients undergoing laparoscopic total hysterectomy,without affecting diaphragmatic function recovery and PACU stay
作者
王建中
刘怡菲
李婷婷
舒爱华
刘力端
Wang Jianzhong;Liu Yifei;Li Tingting;Shu Aihua;Liu Liduan(Department of Anesthesiology,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University&Institute of Geriatric Anesthesia,China Three Gorges University,Yichang 443003,China)
出处
《巴楚医学》
2024年第3期71-75,共5页
Bachu Medical Journal
基金
湖北省自然科学基金项目(No:2022CFC044)
湖北省教育厅科学技术研究项目(No:B2021029)。
关键词
罗哌卡因
膈神经阻滞
膈肌运动幅度
肩痛
ropivacaine
phrenic nerve block
diaphragmatic movement amplitude
shoulder pain
