竖脊肌联合腹横肌平面及颈丛神经阻滞促进食管癌腔镜手术患者快速康复  

Erector spinae combined with transversus abdominis plane and cervical plexus block promoting rapid rehabilitation of patients with esophageal cancer undergoing endoscopic surgery

作　　者：苗民[1,2] 刘伟 饶丽华[1,2] 张振 陈斌[1,2] 戴体俊 MIAO Min;LIU Wei;RAO Li-hua;ZHANG Zhen;CHEN Bin;DAI Ti-jun(Department of Anesthesiology,Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group,Suqain Jiangsu 223800,China;Department of Anesthesiology,Affiliated Suqian Hospital of Xuzhou Medical University,Suqian Jiangsu 223800,China;Department of Anesthesiology and Pharmacology,Xuzhou Medical University,Xuzhou Jiangsu 221004,China)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院麻醉科,江苏宿迁223800 [2]徐州医科大学附属宿迁医院麻醉科,江苏宿迁223800 [3]徐州医科大学麻醉药理学教研室,江苏徐州221004

出　　处：《局解手术学杂志》2021年第6期487-490,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金项目(30872432)。

摘　　要：目的探讨竖脊肌联合腹横肌平面及颈丛神经阻滞对胸—腹腔镜下食管癌三切口手术患者的镇痛效果。方法选取80例行胸—腹腔镜下食管癌三切口手术的老年患者为研究对象,将其随机分为对照组与观察组,每组40例。对照组患者按照常规方法进行麻醉,观察组患者在常规麻醉的基础上加用竖脊肌联合腹横肌平面及颈丛神经阻滞。采用视觉模拟量表(VAS)评分评价2组患者T1(术后1 h)、T2(术后6 h)、T3(术后12 h)、T4(术后24 h)以及T5(术后48 h)静息时和咳嗽时的疼痛情况。比较2组患者丙泊酚及瑞芬太尼用量、麻醉苏醒期相关情况以及术后相关情况。结果2组患者各时间点静息时和咳嗽时的VAS评分比较,差异均有统计学意义(P<0.05);2组患者术中丙泊酚及瑞芬太尼用量比较,差异均有统计学意义(P<0.05);2组患者在苏醒延迟、拔管时间、苏醒期躁动以及转入ICU方面比较,差异均有统计学意义(P<0.05);2组患者术后皮肤瘙痒发生率、肺不张发生率、按压镇痛泵次数、睡眠质量评分以及住院时间比较,差异均有统计学意义(P<0.05)。结论竖脊肌联合腹横肌平面及颈丛神经阻滞可以显著降低胸—腹腔镜下食管癌三切口手术患者在静息时和咳嗽时的疼痛程度和麻醉药物使用量,减少患者麻醉苏醒期及术后不良反应,还能显著降低术后非计划转入ICU率,缩短患者住院时间,有利于患者术后快速康复。Objective To investigate the analgesic effect of erector spinae combined with transversus abdominis plane and cervical plexus block on patients undergoing thoraco-laparoscopic three-incision surgery for esophageal cancer.Methods A total of 80 elderly patients who underwent thoraco-laparoscopic three-incision surgery for esophageal cancer were admitted and randomly divided into the control group and the observation group,with 40 cases in each group.Patients in the control group were treated with the general anesthesia method and those in the observation group were treated with erector spinae combined with transversus abdominis plane and cervical plexus block based on the general anesthesia.Pain at T1(1 hour after operation),T2(6 hours after operation),T3(12 hours after operation),T4(24 hours after operation)and T5(48 hours after operation)during rest and cough between the two groups were evaluated by visual analogue scale(VAS)score.The consumption volumes of propofol and remifentanil,relevant conditions during anesthesia recovery period and postoperative complications between the two groups were compared.Results There were statistically significant differences in VAS scores between the two groups at each time point during rest and cough(P<0.05).There were statistically significant differences in the consumption volumes of propofol and remifentanil between the two groups during the operation(P<0.05).There were statistically significant differences in wake-up delay,extubation time,restlessness in wake-up period and transfer to ICU between the two groups(P<0.05).There were statistically significant differences in incidence of skin itching,atelectasis incidence,times of pressing analgesia pump,sleep quality score and hospital stay after operation between the two groups(P<0.05).Conclusion Erector spinae combined with transversus abdominis plane and cervical plexus block can significantly reduce the pain degree at rest and cough and consumption volumes of anaesthetic drugs,reduce adverse reactions during anesthesia reco

关 键 词：竖脊肌阻滞 腹横肌平面阻滞 颈丛神经阻滞 食管癌三切口手术 老年患者 快速康复 不良反应 

分 类 号：R614.2+7[医药卫生—麻醉学] R735.1[医药卫生—外科学]