摘要
目的比较超声引导下低位前锯肌平面阻滞(SAPB)和腰方肌阻滞(QLB)用于腹腔镜肾癌根治术的应用效果。方法选择行腹腔镜肾癌根治术患者90例,男55例,女35例,年龄18~80岁,BMI 19~28 kg/m^(2),ASAⅠ或Ⅱ级。将患者随机分为三组:SAPB联合全麻组(S组)、QLB联合全麻组(Q组)和单纯全麻组(G组),每组30例。记录神经阻滞操作时间、神经阻滞起效时间、神经阻滞范围、神经阻滞相关并发症发生情况。记录术后0.5、2、12、24、48 h静息和活动时VAS疼痛评分。记录术中丙泊酚和瑞芬太尼用量、补救镇痛例数、术后48 h内镇痛泵按压次数及患者镇痛满意度评分。结果S组阻滞操作时间和阻滞起效时间明显短于Q组(P<0.05)。术后0.5、2、12、24 h S组和Q组静息和活动时VAS疼痛评分以及术后48 h活动时VAS疼痛评分明显低于G组(P<0.05)。S组和Q组术中丙泊酚和瑞芬太尼用量明显少于G组(P<0.05),补救镇痛率明显低于G组(P<0.05),镇痛泵按压次数明显少于G组(P<0.05),镇痛满意度评分明显高于G组(P<0.05)。S组阻滞平面集中在T_(6)—T_(1)1,Q组阻滞平面集中在T_(7)—L_(1)。结论低位SAPB和QLB均可有效缓解腹腔镜肾癌根治术患者术后早期切口痛,减少术中全麻药物用量以及术后镇痛药物用量。与QLB比较,低位SAPB操作更简单、起效时间短,适宜在临床推广应用。
Objective To compare the clinical application of ultrasound-guided serratus anterior plane block(SAPB)and quadratus lumborum block(QLB)in patients undergoing laparoscopic radical nephrectomy.Methods Ninety patients undergoing laparoscopic radical nephrectomy,55 males and 35 females,aged 18-80 years,BMI 19-28 kg/m^(2),ASA physical statusⅠorⅡ,were divided into 3 groups randomly:ultrasound-guided serratus anterior plane block combined with general anesthesia group(group S),quadratus lumborum block combined with general anesthesia group(group Q)and general anesthesia group(group G),30 patients in each group.The operation time of block,block plane,effective time,adverse reactions were all recorded.Visual analogue scale(VAS)score at rest and during exercise were recorded 0.5,2,12,24,and 48 hours after surgery.The consumption of anesthetic(propofol and remifentanil),the frequency of pressing patient controlled intravenous analgesia(PCIA)during 48 hours after operation and the cases of remedial analgesia were all recorded.Results The operation time and effective time of block in group S was less than that in group Q(P<0.05).Compared with group G,the VAS scores at rest and during exercise 0.5,2,12,and 24 hours after surgery and VAS score during exercise 48 hours after surgery in groups S and Q were significantly lower(P<0.05),the total consumption of anesthetic,the cases of remedial analgesia,the pressing frequency of PCIA were significantly less in groups S and Q(P<0.05),the satisfaction scores in group S and group Q were also better(P<0.05).The block plane of group S was concentrated between T_(6)-T_(11),while group Q was concentrated between T_(7)-L_(1).Conclusion Both SAPB and QLB were effective for postoperative analgesia,which can reduce the usage of anesthetic and analgesic.Compared with QLB,SAPB was more simple and secure,and easier applied in clinic.
作者
丁可
单涛
曹媛媛
张晨
孙蓓
葛德高
鲍红光
陈利海
DING Ke;SHAN Tao;CAO Yuanyuan;ZHANG Chen;SUN Bei;GE Degao;BAO Hongguang;CHEN Lihai(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2021年第9期929-932,共4页
Journal of Clinical Anesthesiology
基金
江苏省“六大人才高峰”项目(YY-104)。
关键词
前锯肌平面阻滞
腰方肌阻滞
腹腔镜
肾癌根治术
术后镇痛
Serratus anterior plane block
Quadratus lumborum block
Laparoscopic
Radical nephrectomy
Postoperative analgesia
