摘要
目的近年来对疾病治疗期间舒适性有更高要求,在多模式镇痛下,应合理选择麻醉方法。本研究分析在术后镇痛中超声引导下不同入路腹横肌平面阻滞与切口局部浸润麻醉临床应用效果。方法选取2018-02-07-2019-06-10许昌市人民医院实施腹腔镜肾切除术90例患者作为研究对象,根据年龄和体质量分成3组,各30例。侧路法组患者给予超声引导下腹横肌平面阻滞侧路法,后路法组患者给予后路法,浸润法组患者给予切口局部浸润法,比较3组切皮前后血流动力学变化程度、各时间点视觉模拟评分(visual analogue scale,VAS)及镇静(ramsay sedation score,Ramsay)评分。结果侧路法组和后路法组术后6hVAS评分分别为(0.57±0.21)和(0.58±0.17)分,均低于浸润法组的(3.33±0.13)分,F=2532.848,P<0.001;术后12hVAS评分分别为(1.87±0.32)和(1.86±0.28)分,均低于浸润法组的(4.87±0.43)分,F=740.779,P<0.001;术后24hVAS评分分别为(2.60±0.16)和(2.56±0.22)分,均低于浸润法组的(4.97±0.13)分,F=1885.578,P<0.001;术后48hVAS评分分别为(2.62±0.22)和(2.57±0.33)分,均低于浸润法组的(4.88±0.35)分,F=560.018,P<0.001。侧路法组和后路法组术后6hRamsay评分分别为(3.60±0.21)和(3.61±0.12)分,均高于浸润法组的(1.02±0.11)分,F=2839.504,P<0.001;术后12hRamsay评分分别为(3.22±0.32)和(3.21±0.21)分,均高于浸润法组的(1.22±0.41)分,F=379.539,P<0.001。结论与切口局部浸润麻醉比较,超声引导下侧入路、后入路腹横肌平面阻滞对腹腔镜肾切除术后镇痛及镇静效果更佳,且血流动力学平稳。
OBJECTIVE At this stage,people have higher requirements for comfort during the treatment of the disease.Under multi-mode analgesia,anesthesia methods should be selected reasonably.This study analyzes the plane of transverse abdominal muscles under different ultrasound guidance during postoperative analgesia Clinical application of block and incision local infiltration anesthesia.METHODS A total of 90 patients who underwent laparoscopic nephrectomy in our hospital from February 7,2018 to June 10,2019 were selected.They were divided into three groups according to the age and weight of the patients,30 cases each.Patients in the lateral approach group were given ultrasound-guided lateral transverse abdominal plane block lateral approach,patients in the posterior approach group were given posterior approach,and patients in the infiltration group were given local incision incision.The hemodynamic changes of the three groups visual analogue scale(VAS),sedation(Ramsay)score at each time point were compared before and after incision.RESULTS The 6-hour postoperative VAS scores of the lateral approach group and the posterior approach group were(0.57±0.21)and(0.58±0.17)points,respectively,which were lower than the(3.33±0.13)points of the infiltration method group,F=2532.848,P<0.001.The 12-hour postoperative VAS scores of the lateral and posterior methods were(1.87±0.32)and(1.86±0.28),respectively,which were lower than the(4.87±0.43)points of the infiltration method,and F=740.779,P<0.001.The 24 hour postoperative VAS scores of the lateral approach group and the posterior approach group were(2.60±0.16)and(2.56±0.22)points,respectively,which were lower than the(4.97±0.13)points of the infiltration method group,F=1885.578,P<0.001.The VAS scores of the lateral approach group and the posterior approach group at 48 hafter surgery were(2.62±0.22)and(2.57±0.33),which were lower than those of the infiltration method group(4.88±0.35).F=560.018,P<0.001.The 6-hour Ramsay scores of the lateral approach group and the posterior approach group were(3.60±0.21)and(3.61±0.12)points,respectively,which were higher than the(1.02±0.11)points of the infiltration method group,F=2839.504,P<0.001.The 12-hour Ramsay scores of the lateral approach group and the posterior approach group were(3.22±0.32)and(3.21±0.21)points,respectively,which were higher than the(1.22±0.41)points of the infiltration method group,F=379.539,P<0.001.CONCLUSION Compared with local infiltration anesthesia for incision,ultrasound-guided lateral and posterior approaches of transverse transverse abdominal plane block have better analgesia and sedation after laparoscopic nephrectomy,and the hemodynamics is stable.
作者
葛秀芳
李会云
GE Xiu-fang;LI Hui-yun(Department of Anesthesiology,Xuchang People's Hospital,Xuchang461000,P.R.China)
出处
《社区医学杂志》
2020年第7期521-524,共4页
Journal Of Community Medicine
关键词
超声引导
腹横肌平面阻滞
局部浸润麻醉
腹腔镜肾切除
术后镇痛
ultrasound guidance
transverse abdominal muscle plane block
local infiltration anesthesia
laparoscopic nephrectomy
postoperative analgesia
