超声下腹直肌鞘阻滞在腹式全子宫切除术中的应用  

The efficacy of ultrasound guided rectus sheath block in patients undergoing total abdominal hysterectomy

作　　者：刘金变[1] 单嘉琪[1] 严海[1] 万名柢 江伟[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,200233

出　　处：《临床麻醉学杂志》2013年第7期649-651,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察超声引导下腹直肌鞘阻滞(RSB)在腹式全子宫切除术中和术后的作用。方法拟行腹式全子宫切除术患者40例,ASAⅠ或Ⅱ级,随机均分为两组:罗哌卡因组(R组)和生理盐水组(S组)。麻醉诱导后在超声下行双侧RSB,R组注射0.5%罗哌卡因20ml,S组注射等容量生理盐水。所有患者术后均行PCIA,维持VAS评分≤3分。记录两组切皮前后HR、SBP、DBP差值(ΔHR、ΔSBP、ΔDBP)、术中芬太尼和维库溴铵用量、术毕拔管时间、术后24h的PCIA药物用量和恶心呕吐的发生情况。结果 R组切皮前后的ΔHR、ΔSBP和ΔDBP明显小于S组(P<0.05)。R组术中芬太尼、维库溴铵用量及术后24hPCIA药物用量明显少于S组,术毕R组拔管时间明显短于S组(P<0.05)。R组术后恶心呕吐发生率低于S组,但两组差异无统计学意义。结论超声引导下RSB定位准确,操作简便,术中和术后镇痛效果确切,不良反应少,是腹式全子宫切除术麻醉和镇痛方式的有效补充。Objective To observe intraoperative and postoperative effects of ultrasound guided rectus sheath block （RSB） in patients undergoing total abdominal hysterectomy. Methods Forty ASA I or II patients undergoing total abdominal hysterectomy were randomly divided into two groups （n=20 each）., ropivacaine group （group R） and normal saline group （group S）. Ultrasound guided bilateral RSB was performed after induction of anesthesia. Group R was injected with 0.5% ropivacaine 20 ml and group S was injected with an equal volume of normal saline All patients received patient controlled intravenous analgesia （F^IA） after operation and VAS score was maintained ~ 3. differenced of HR,SBP and DBP before and after skin incision （AHR, ASBP and ＆DBP）, consumption of fentanyl and veeuroniurn during operation, extubation time, consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation of the two groups were recorded. Results Compared with group S, group R had less AHR, △SBP and △DBP during skin incision （P〈0. 05）. The consumption of fentanyl and vecuronium during operation was signifieantly lower in group R. Postoperative recovery time and consumption of analgesics were significantly reduced in group R （P〈0. 05）. The occurrence of postoperative nausea and vomiting was lower in group R than in group S, but did not have statistical difference. Conclusion It is easy and accurate to perform RSB by ultrasound guided technique. It provides better intraoperative and postoperative analgesia with lower adverse effects, which is an effective complement for total abdominal hysterectomy anesthesia and analgesia.

关 键 词：超声 腹直肌鞘阻滞 子宫切除术 镇痛 

分 类 号：R614[医药卫生—麻醉学]