超声引导下低位前锯肌平面阻滞用于机器人辅助肾切除手术镇痛效果的研究  

Observation on the Analgesic Effect of Ultrasonic Guidance Subserratus Plane Block in Robot-assisted Laparoscopic Radical Nephrectomy

作　　者：廖家涛 黎笔熙 宋晓阳 徐孟达 Liao Jiatao;Li Bixi;Song Xiaoyang(Department of Anesthesiology,General Hospital of the Central Theater of the Chinese People′s Liberation Army,Hubei 430070,China)

机构地区：[1]中国人民解放军中部战区总医院,武汉430070

出　　处：《医学研究杂志》2021年第1期141-144,36,共5页Journal of Medical Research

摘　　要：目的研究超声引导下低位前锯肌平面阻滞(subserratus plane block,SSPB)用于达芬奇机器人辅助腹腔镜下肾切除手术(RALRN)中镇痛效果。方法选择2019年7月~2020年7月择期行达芬奇机器人辅助腹腔镜下肾切除手术的患者60例,随机分为单纯全身麻醉组(G组,n=30)和全身麻醉联合低位前锯肌平面阻滞组(S组,n=30),G组常规行全身麻醉,S组在麻醉诱导前行T 8~T 9前锯肌平面阻滞,麻醉完成后均行达芬奇机器人辅助腹腔镜下肾切除手术。记录两组开始切皮放置Trocar前(T 0)和放置Trocar完成后(T 1)的平均动脉压(MAP)及心率(HR);记录两组患者术中丙泊酚、瑞芬太尼用量;观察两组术后1、6、12、24、48h静息时疼痛视觉模拟评分(VAS)及镇痛泵有效按压次数。结果T 1时S组MAP较G组低,HR较G组更慢(P<0.05),S组术中丙泊酚及舒芬太尼用量少于G组(P<0.05),术后1、6、12、24h静息时VAS疼痛评分低于G组(P<0.05),术后镇痛泵有效按压次数低于G组(P<0.05)。结论超声引导下低位前锯肌平面阻滞在达芬奇机器人辅助腹腔镜下肾切除手术中可提供安全有效的镇痛。Objective To evaluate the analgesic effect of ultrasonic guidance subserratus plane block combined with general anesthesia for robot-assisted laparoscopic radical nephrectomy.Methods Sixty patients who underwent robot-assisted laparoscopic radical nephrectomy at general hospital of central theater command from July 2019 to July 2020 were enrolled.Patients were divided into group S(SSPB combined with general anesthesia)and group G(general anesthesia)randomly,n=30 for each group.Patients in group G received general anesthesia without regional never block,while patients in group S received general anesthesia combined with ultrasonic guidance subserratus plane block.Mean arterial pressure and heart rate were recorded throughout the Trocar placement.The consumption of propofol and remifentanil during peri-operation were documented.The visual simulation score for pain and the times of effective compressions of PCA was recorded 1h,6h,12h,24h,48h postoperative.Results Hemodynamics were more stable in group S than group G during Trocar placement(P<0.05).Consumption of propofol and remifentanil were lower in group S(P<0.05).Patients in group G needed more effective compressions of PCA and showed higher VAS score than group S(P<0.05).Conclusion Ultrasonic guidance subserratus plane block could provide safe and effective analgesic in robot-assisted laparoscopic radical nephrectomy.

关 键 词：超声引导 前锯肌阻滞 达芬奇机器人 肾切除术 镇痛 

分 类 号：R614[医药卫生—麻醉学]