肾移植术前两种神经阻滞对术中及术后智能化病人自控镇痛药物用量的影响  

The effect of two kinds of preoperative nerve block on the intra-and postoperative Ai-PCA analgesic consump-tion for renal transplantation

作　　者：沈月坤 陈晓翔 熊玮[1] 杨璐[1] 黄文起[1] SHEN Yue-kun;CHEN Xiao-xiang;XIONG Wei;YANG Lu;HUANG Wen-qi(Department of Anesthesiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,Guangdong,China)

机构地区：[1]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《广东医学》2020年第11期1101-1105,共5页Guangdong Medical Journal

摘　　要：目的研究肾移植术前两种神经阻滞对术中及术后智能化病人自控镇痛(Ai-PCA)镇痛药物用量的影响.方法回顾分析113例14岁以上、ASAⅡ~Ⅳ级、术后行单一舒芬太尼静脉Ai-PCA的肾移植手术病例资料,根据神经阻滞方式分为3组:术后单纯静脉PCA组(IV组,n=45)、术前腹横肌平面(TAP)阻滞+术后静脉PCA组(TAP组,n=36)及术前TAP+髂腹股沟髂腹下神经(IIIH)阻滞+术后静脉PCA组(TAP+IIIH组,n=32);3组患者一般资料组间比较差异无统计学意义(P>0.05).观察主要指标为术中及术后72 h舒芬太尼使用量,次要指标为术后24 h VAS评分及镇痛不良反应.结果3组患者手术基本情况组间比较差异无统计学意义(P>0.05);术后24 h VAS评分及不良反应发生率差异无统计学意义(P>0.05).术中舒芬太尼的使用量上TAP组和TAP+IIIH组明显低于IV组(P<0.05),但TAP组和TAP+IIIH组对比差异无统计学意义(P=0.2544).IV组在术后72 h舒芬太尼使用量和平均每天使用量上与TAP组存在显著性差异(P<0.05),其他组间比较差异无统计学意义(P>0.05).结论肾移植术前TAP阻滞和TAP+IIIH阻滞均能减少术中舒芬太尼的使用,TAP阻滞可减少术后舒芬太尼的使用,而TAP+IIIH阻滞无明确证据证明较单纯TAP阻滞可进一步减少围术期舒芬太尼用量.Objective To study the effect of two kinds of preoperative nerve block on the intra-and postoperative AI-PCA analgesic consumption for renal transplantation.Methods A retrospective chart review was conducted by querying the clinical data of 113 parients receiving renal transplantations.The criteria for inclusion were the patient over 14 years old,with ASA Ⅱ—Ⅳ,and received single intravenous sufentanil Ai-PCA.The primary outcome was postoperative morphine equivalent consumption.In the included 113 cases,45 received no regional block(Group Ⅳ),36 received TAP block(Group TAP)and 32 received TAP+ⅢH block(Group TAP+ⅢH).The primary outcome measured was the perioperative sufentanil consum ption,the secondary outcome was VAS score 24 h after operation and incidence of adverse reactions.Results Baseline surgical characteristics were not significantly different among the three groups,neither was postoperative VAS score in 24 h nor incidence of adverse reactions.The intraoperative sufentanil consumption of Group Ⅳ was significantly less than Group TAP group and TAP+ⅢH(P<0.05),while between Group TAP group and TAP+ⅢH there was no significantly different(P=0.2544).Postoperative sufentanil consumption in 72 h and average daily consumptions were significantly different between Group Ⅳ and TAP(P<0.05),but not significantly between the other groups.Conclusion Compared with intravenous analgesia alone,preoperative administration of TAP block and TAP+ⅢH block both could reduce intraoperative sufentanil consumption in renal transplantation,and TAP block could reduce postoperative sufentanil consumption.Compared with TAP block,TAP+ⅢH block is not proved to reduce perioperative sufentanil consumption.

关 键 词：肾移植 腹横肌平面阻滞 髂腹股沟髂腹下神经阻滞 人工智能 病人自控镇痛 

分 类 号：R441.1[医药卫生—诊断学] R614[医药卫生—临床医学]