竖脊肌平面阻滞与切口浸润麻醉对全麻胸腔镜肺部分切除术患者术后早期恢复影响的比较
Comparison of effects of transverse abdominis plane block and incision infiltration anesthesia on ear-ly postoperative recovery in patients undergoing thoracoscopic lung resection with general anesthesia
张玲玲 1王平 2王志刚 3陈永学 3苑进革3
作者信息
- 1. 邯郸市中心医院麻醉科,邯郸 056008;河北北方学院研究生院,张家口 075000
- 2. 石家庄市第四医院麻醉科,石家庄 050000
- 3. 邯郸市中心医院麻醉科,邯郸 056008
- 折叠
摘要
目的 比较竖脊肌平面阻滞与切口浸润麻醉对全麻胸腔镜肺部分切除术患者术后早期恢复的影响.方法 选取拟在全麻胸腔镜下行肺部分切除术患者80例,性别不限,年龄50～78岁,BMI 18～30 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=40):切口局部浸润组(D组)和竖脊肌平面阻滞组(E组).E组在麻醉诱导完成,改为侧卧位后,在超声引导下行患侧竖脊肌平面阻滞,注射0.25％盐酸罗哌卡因30ml;D组切皮前采用0.25％盐酸罗哌卡因行切口浸润麻醉.术后行自控静脉镇痛,当静态NRS评分＞3分或咳嗽时NRS评分≥6分时,静脉注射氟比洛芬酯补救镇痛.分别于术前1 d和术后24、48 h时行QOR-15评分.分别于切皮前、术毕和术后24 h时,采用ELISA法测定血浆IL-6和IL-1β浓度.记录术中瑞芬太尼用量、术后48 h内镇痛泵有效按压次数、补救镇痛情况、术后首次下床活动时间、首次肛门排气时间、住院时间和术后48 h内恶心呕吐、肺部感染的发生情况.结果 与D组比较,E组术后24和48 h时QOR-15评分升高,术中瑞芬太尼用量和镇痛泵有效按压次数减少,补救镇痛率降低,首次补救镇痛时间延长,术后首次肛门排气时间缩短(P＜0.05).2组间各时点血浆IL-6、IL-1β浓度、术后首次下床活动时间、住院时间和恶心呕吐、肺部感染发生率比较差异无统计学意义(P＞0.05).结论 相对于切口浸润麻醉而言,竖脊肌平面阻滞用于全麻胸腔镜肺部分切除术,可减少术中阿片类药物用量,减轻术后疼痛,促进术后早期恢复.
Abstract
Objective To compare the effects of transverse abdominis plane block and incision in-filtration anesthesia on the early postoperative recovery in the patients undergoing thoracoscopic lung resec-tion with general anesthesia.Methods Eighty American Society of Anesthesiologists Physical Status classi-fication Ⅱ or Ⅲ patients,regardless of gender,aged 50-78 yr,with body mass index of 18-30 kg/m2,scheduled for elective thoracoscopic lung resection under general anesthesia,were divided into 2 groups(n=40 each)using a random number table method:incision local infiltration group(group D)and trans-verse abdominis plane block group(group E).In group E,the patients were changed to the lateral position after completion of anesthesia induction,ultrasound-guided transverse abdominis plane block was performed on the affected side,with 0.25％ropivacaine hydrochloride 30 ml injected.In group D,infiltration anesthe-sia with 0.25％ropivacaine hydrochloride was performed before incision.Postoperative patient-controlled in-travenous analgesia was carried out,and flurbiprofen axetil was intravenously injected for rescue analgesia when the numerical rating scale score at rest＞3 or numerical rating scale score ≥6 while coughing.Quality of Recovery-15 scale scores were assessed at 1 day before surgery and 24 and 48 h after surgery.Plasma concentrations of interleukin-6(IL-6)and IL-1β were measured by enzyme-linked immunosorbent assay be-fore incision,at the end of surgery,and at 24 h after surgery.The amount of remifentanil used during sur-gery,the number of effective pressing times of patient-controlled analgesia within 48 h after surgery,re-quirement for rescue analgesia,first ambulation time after surgery,time to first flatus,length of hospital stay,and occurrence of nausea and vomiting and pulmonary infection within 48 h after surgery were recor-ded.Results Compared with group D,Quality of Recovery-15 scale scores were significantly increased,the amount of remifentanil used during surgery and the number of effective pressing times of patient-con-trolled analgesia were reduced,the rate of rescue analgesia was decreased,the time to first rescue analgesia was prolonged,and the time to first flatus was shortened in group E(P＜0.05).There were no significant differences in the plasma concentrations of IL-6 and IL-1β at various time points,time to first ambulation af-ter surgery,length of hospital stay,and incidence of nausea and vomiting and pulmonary infection between the two groups(P＞0.05).Conclusions Compared with incision infiltration anesthesia,transverse abdomi-nis plane block can reduce intraoperative consumption of opioids,alleviate postoperative pain,and promote early postoperative recovery when used for thoracoscopic lung resection under general anesthesia.
关键词
神经传导阻滞/麻醉,局部/麻醉,全身/胸腔镜检查/肺切除术/竖脊肌Key words
Nerve block/Anesthesia,local/Anesthesia,general/Thoracoscopy/Pneumo-nectomy/Erector spinae引用本文复制引用
出版年
2024
NETL
NSTL
万方数据