超声引导下椎旁神经阻滞和蛛网膜下腔阻滞用于单侧开放性疝修补术的麻醉效果  

Comparison of anesthesia and analgesia effects between ultrasound-guided paravertebral block and subarachnoid block for unilateral open inguinal herniorrhaphy

作　　者：张南南 王爱忠[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《上海医学》2017年第12期751-755,共5页Shanghai Medical Journal

基　　金：上海市适宜技术推广项目(2013SY031);上海市浦东新区科技发展基金创新资金项目(PKJ2013-Y69);上海市浦东新区卫生和计划生育委员会科技发展专项基金项目(PW2015B-18)资助

摘　　要：目的比较超声引导下椎旁神经阻滞和蛛网膜下腔阻滞用于单侧开放性腹股沟疝修补术的麻醉和镇痛效果。方法选取2015年1月—2016年1月行单侧开放性腹股沟疝修补术的患者40例,男36例,女4例,年龄18~82岁,BMI均<30kg/m^2,美国麻醉医师协会(ASA)分级Ⅰ至Ⅲ级。按照随机数字表分为超声引导下椎旁神经阻滞组和蛛网膜下腔阻滞组,每组20例。椎旁神经阻滞组在超声引导下行T_(12)和L_1椎旁神经阻滞,注入0.5%罗哌卡因各20mL;蛛网膜下腔阻滞组在L_3与L_4间隙穿刺,注入罗哌卡因20~30mg。记录两组患者的麻醉阻滞平面、阻滞成功率和舒芬太尼使用情况。分别于麻醉前、注射局部麻醉药后15min(注药后15min)、注射局部麻醉药后40min(注药后40min)、手术结束时、术后6h记录两组患者的心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP),分别于麻醉后监测治疗室(PACU)中、术后4h、术后12h、术后24h、术后48h对两组患者进行静态和动态疼痛视觉模拟评分(VAS评分)。镇痛结束时进行患者满意度评分,手术结束后进行手术医师满意度评分,于术后当日评价患者的睡眠质量,记录术后患者自控镇痛(PCA)有效按压次数。观察两组不良反应情况和导尿管的使用情况。结果椎旁神经阻滞组使用舒芬太尼的患者比例显著高于蛛网膜下腔阻滞组(P<0.05),两组间阻滞成功率的差异无统计学意义(P>0.05)。椎旁神经阻滞组注药后15、40min和手术结束时的SBP、DBP、MAP均显著高于蛛网膜下腔阻滞组同时间点(P值均<0.05)。蛛网膜下腔阻滞组注药后15 min时的HR显著快于同组麻醉前(P<0.05),注药后15、40 min和手术结束时的SBP、DBP、MAP均显著低于同组麻醉前(P值均<0.05)。椎旁神经阻滞组术后4、12、24、48h时的静态疼痛VAS评分和术后4、12h时的动态疼痛VAS评分均显著低于蛛网膜下腔阻滞组同时间点(P值均<0.05)。椎旁神经阻滞组的Objective To compare anesthesia and analgesia effects between ultrasound-guided paravertebral block and subarachnoid block for unilateral open inguinal herniorrhaphy. Methods From January 2015 to January 2016, 40 patients （36 males and 4 females）, American Society of Anesthesiologists （ASA） grade Ⅰ - Ⅲ, BMI〈30 kg/m2 , aged 18 - 82 years, scheduled for unilateral open inguinal herniorrhaphy were equally and randomly assigned to two groups. The patients in group U received ultrasound-guided unilateral paravertebral block at the levels of T12 and L1 with 20 mL 0.5% ropivacaine. In group S, subarachnoid anesthesia was appliedwith 20 - 30 mg ropivacaine at the L3 - L4 levels. The anesthetic block level, success rate of anesthesia and use of sufentanil were recorded. Heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and mean arterial pressure （MAP） were recorded before anesthesia, at 15 min after the injection of local anesthetic, at 40 min after injection of local anesthetic, at the end of surgery and at 6 h after operation. Visual analogue scale （VAS） scores at rest and movement were recorded at PACU and at 4, 12, 24, and 48 hours after surgery. The frequency of patient controlled analgesia（PeA）, sleep quality on the night of operative day-and the degree of satisfaction of surgeons and patients were recorded. Adverse reactions and the ratio of indwelling urinary catheter were observed. Results The constituent ratio of patients using sufentanil in group U was significantly higher than that in Group S （P〈0.05）. However, there was no statistical difference in success rate of anesthesia between the groups （P〉0.05）. SBP, DBP and MAP at 15 min and 40 min after injection of local anesthetic and at the end of surgery were significantly higher in group U than those in group S （all P〈0.05）. HR at 15 min after injection of local anesthetic was significantly faster than that before anesthesia （P〈0.05） in group S. SBP, DBP and MAP at 15 min

关 键 词：超声引导 椎旁神经阻滞 疝修补术 

分 类 号：R614[医药卫生—麻醉学]