超声引导下竖脊肌平面阻滞对腹腔镜下直肠癌根治术后镇痛的效果  

Clinical significance of ultrasound-guided erector spinae plane block in postoperative analgesia after laparoscopic radical resection of rectal cancer

作　　者：李朝阳[1] 李东林 林义办[1] 郭校锡[1] 张梓朗 陈华显 邓建中[1] Zhao-yang Li;Dong-lin Li;Yi-ban Lin;Xiao-xi Guo;Zi-lang Zhang;Hua-xian Chen;Jian-zhong Deng(Department of Anorectal Surgery,The First People’s Hospital of Foshan,Guangdong 528000,China;Department of Anesthesiology,The First People’s Hospital of Foshan,Guangdong 528000,China)

机构地区：[1]佛山市第一人民医院肛肠外科,广东佛山528000 [2]佛山市第一人民医院麻醉科,广东佛山528000

出　　处：《中国现代医学杂志》2020年第17期81-85,共5页China Journal of Modern Medicine

摘　　要：目的探讨超声引导下竖脊肌平面阻滞对腹腔镜下直肠癌根治术后镇痛的影响。方法选取2018年1月—2018年12月佛山市第一人民医院行腹腔镜下直肠癌根治术患者60例。采用随机数字表法分为对照组和竖脊肌平面阻滞组(阻滞组),每组30例。阻滞组麻醉诱导前在双侧T8横突行单次竖脊肌平面阻滞,对照组不行阻滞,然后在静吸复合麻醉下行直肠癌根治术。术毕两组均采用静脉自控镇痛(PCIA)。记录气管导管拔管后即刻(T0)、术后3 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、36 h(T5)和48 h(T6)时静态VAS评分,记录T4~T6时动态VAS评分(患者在病床上翻身和坐起时)。统计术后0~24 h和>24~48 h舒芬太尼用量。记录患者镇痛泵首次按压时间、需要补救性镇痛的比例、肛门排气时间、首次下床活动时间和停留尿管时间,记录患者术后恶心呕吐、瘙痒、呼吸抑制和低氧血症发生率。术后48 h评估两组患者总体满意度。结果与对照组患者比较,阻滞组患者在T0~T6时静态VAS评分和T4~T6时动态VAS评分均降低(P<0.05);与对照组患者比较,阻滞组患者首次按压镇痛泵的时间延长,术后24和48 h内舒芬太尼用量减少(P<0.05),需要补救性镇痛的例数减少(P<0.05);与对照组患者比较,阻滞组患者术后恶心呕吐发生率降低(P<0.05),而两组瘙痒、呼吸抑制和低氧血症发生率比较,差异无统计学意义(P>0.05);与对照组患者比较,阻滞组患者术后肛门排气时间、首次下床活动时间和停留尿管时间均缩短(P<0.05);阻滞组患者术后48 h总体满意度评分为(3.8±1.1)分,高于对照组患者的(1.8±0.7)分(P<0.05)。结论超声引导下竖脊肌平面阻滞能够为腹腔镜下直肠癌根治术患者提供良好的术后镇痛。Objective To observe the effects of ultrasound-guided single erector spinae plane block (ESPB) on postoperative pain in patients undergoing laparoscopic radical resection of rectal cancer.Methods Sixty patients scheduled for laparoscopic radical resection of rectal cancer were randomly assigned into two groups,ESPB group and control group.ESPB was performed in group E before anesthesia induction.Visual analogue scale (VAS) scores were recorded at immediately after the extubation (T0),3h (T1),6h (T2),12h (T3),24h (T4),36h (T5) and 48h (T6) after operation.At T4 to T6,the active exercise VAS scores were recorded.The first time of pressing the analgesic pump,the volume of analgesic drugs,the side effects and patients’ overall satisfaction were recorded.Recovery time of gastrointestinal function,ambulation time,the time of catheter retention were recorded as well.Results The VAS scores both at rest and exercise in group ESPB were lower than those in control group (P<0.05).The number of remedial analgesia and the volume of analgesic drugs were significantly less in group ESPB than those in control group (P<0.05).The incidence rate of nausea and vomiting was significantly lower in ESPB group than that in control group (P<0.05).The patient in the group has a prolonged recovery time of gastrointestinal function,ambulation time and the time of catheter retention (P<0.05).And the degree of satisfaction in ESPB group was significantly higher than that in control group (P<0.05).Conclusion Ultrasound-guided erector spinae plane block can provide effective postoperative analgesia on patients who undergoing laparoscopic radical resection of rectal cancer.

关 键 词：直肠肿瘤 竖脊肌平面阻滞 超声引导 腹腔镜手术 

分 类 号：R735.37[医药卫生—肿瘤] R614.4[医药卫生—临床医学]