超声引导下腹直肌鞘阻滞联合肋缘下腹横肌平面阻滞用于腹膜透析置管术的临床研究  

Application of ultrasound-guided rectus sheath block combined with subcostal transversus abdominis plane block in peritoneal dialysis catheter implantation

作　　者：王加芳[1] 戚忠 万胜[2] 祝德刚[1] 陈治军 Wang Jiafang;Qi Zhong;Wan Sheng;Zhu Degang;Chen Zhijun(Department of Anesthesiology,Wuhan First Hospital,Wuhan 430022,China;Department of Nephrology,Wuhan First Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院麻醉科,430022 [2]武汉市第一医院肾内科,430022

出　　处：《中国医师进修杂志》2020年第8期707-712,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的评估超声引导下腹直肌鞘阻滞联合肋缘下腹横肌平面阻滞用于腹膜透析置管术的安全性和有效性。方法选择2018年6月至2019年3月武汉市第一医院择期行腹膜透析置管术的终末期肾病患者60例作为研究对象,采用随机数字表法将患者分为局部麻醉组(LA组,30例)和超声引导下腹直肌鞘阻滞联合肋缘下腹横肌平面阻滞组(NB组,30例)。LA组:术前给予1%利多卡因+0.5%罗哌卡因混合液20 ml在手术切口和手术路径进行局部浸润麻醉。NB组:行术侧超声引导下腹直肌鞘阻滞联合肋缘下腹横肌平面阻滞,腹直肌鞘内注射1%利多卡因+ 0.5%罗哌卡因15 ml,腹横肌平面给予1%利多卡因+ 0.5%罗哌卡因20 ml。记录患者入室时(T0)、麻醉完成后(T1)、手术开始切皮时(T2)、手术开始后20 min(T3)、手术结束时(T4)的心率(HR)和平均动脉压(MAP)。记录两组患者手术时间,术中补救镇痛次数,术中、术后24 h的疼痛视觉模拟评分(VAS),因无法耐受转换为全身麻醉的比率和麻醉相关不良反应。结果与T0时比较,T2和T3时LA组HR明显增快[(93.1 ± 9.7)、(99.8 ± 11.6)次/min比(78.4 ± 10.5)次/min]、MAP明显升高[(105.1 ± 13.7)、(110.5 ± 14.4)mmHg(1 mmHg=0.133 kPa)比(92.1 ± 12.8)mmHg](P<0.05),NB组各时点HR和MAP比较差异无统计学意义(P>0.05)。与LA组比较,NB组T2和T3时的HR和MAP均明显降低(P<0.05)。NB组手术时间明显短于LA组[(70.67 ± 7.39)min比(82.57 ± 8.09)min](P<0.05)。LA组术中补救镇痛次数明显多于NB组(48次比10次)(P<0.05)。NB组术中和术后24 h的疼痛VAS评分明显低于LA组[(3.25 ± 0.65)分比(5.85 ± 0.76)分、(1.46 ± 0.57)分比(2.37 ± 0.45)分](P<0.05)。LA组转全身麻醉率为3.33%(1/30),NB组患者均顺利完成手术,两组比较差异无统计学意义(P>0.05)。两组患者术后均无明显麻醉相关不良事件发生。结论超声引导下腹直肌鞘阻滞联合肋缘下腹横肌平面阻滞用于腹膜透析置管术是安全Objective To discuss the efficacy and safety of ultrasound-guided rectus sheath block(RSB)combined with subcostal transversus abdominis plane block(TAPB)in peritoneal dialysis catheter implantation in patients with end-stage renal disease.Methods A total of sixty patients(scheduled for elective peritoneal dialysis catheter placement from June 2018 to March 2019 in Wuhan First Hospital were randomly divided into two groups:local anesthesia group(group LA,30 patients)and ultrasound-guided RSB combined with subcostal TAPB(group NB,30 patients).Group LA:local infiltration anesthesia was performed with 1%lidocaine and 0.5%ropivacaine 20ml;group NB:RSB,1%lidocaine and 0.5%ropivacaine 15 ml were injected into the lateral rectus sheath,and TAPB,1%lidocaine and 0.5%ropivacaine 20 ml were injected into the transversus abdominis plane.Mean arterial blood pressure(MAP)and heart rate(HR)were recorded at the point of entering the operating room(T0),after anaesthesia(T1),at the beginning of operation(T2),twenty minutes after the beginning of operation(T3),and at the end of the operation(T4).The duration of operation,the times of additional local anesthetia during the surgery,the score of visual analogue scale(VAS)during and 24 h after the surgery,the rate of alteration to general anesthesia and the occurrence of adverse reactions were recorded.Results In group LA,compared with T0,MAP and HR at T2 and T3 increased significantly:(93.1±9.7),(99.8±11.6)times/min vs.(78.4±10.5)times/min and(105.1±13.7),(110.5±14.4)mmHg(1 mmHg=0.133 kPa)vs.(92.1±12.8)mmHg,P<0.05.In group NB,there were no differences among T0-T4.At T2 and T3,MAP and HR in group LA were higher than those in group NB(P<0.05).Compared with that in group LA,the duration of operation time decreased significantly in group NB(P<0.05).The times of additional local anesthetia during the surgery in group LA were more than those in group NB(P<0.05).Compared with those in group LA,the VAS scores during and 24 h after the surgery in group NB were significantly lower:(3.25±0

关 键 词：超声检查 麻醉 局部 腹膜透析 导管 留置 腹直肌鞘阻滞 

分 类 号：R614[医药卫生—麻醉学]