改良肋缘下入路行腹横肌平面阻滞联合腹直肌鞘阻滞用于腹膜透析置管术的临床观察  

Clinical observation of modified lower costa surgical approach for transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization

作　　者：罗杰 张云芳 曾德望 肖洁[1] Luo Jie;Zhang Yunfang;Zeng Dewang;Xiao Jie(Department of Nephrology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Nephrology,Huadu Hospital of Southern Medical University,Huadu District People′s Hospital of Guangzhou City,the Third School of Clinical Medicine of Southern Medical University,Guangzhou 510800,China)

机构地区：[1]广州医科大学附属第一医院肾内科,510120 [2]南方医科大学附属花都医院(广州市花都区人民医院)南方医科大学第三临床医学院肾病学科,510800

出　　处：《中国医师进修杂志》2021年第5期434-439,共6页Chinese Journal of Postgraduates of Medicine

基　　金：广州市科技计划(201804010066);广州市花都区科技计划(18-HDWS-042)。

摘　　要：目的探讨改良肋缘下入路(mLS)行腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)用于外科切开法腹膜透析置管术(PDC)的安全性及有效性。方法选取2018年1—12月广州市花都区人民医院拟行择期PDC慢性肾脏病5期患者40例,将患者按随机数字表法分为三组:采用mLS行TAPB联合RSB 13例(TAPB联合RSB组),侧边入路联合臀部入路(LP)行TAPB 13例(TAPB组),局部麻醉(LA)14例(LA组)。记录切皮(T0)、分离腹直肌(T1)、置入腹膜透析导管(T2)和缝合皮肤及做皮下隧道(T3)时平均动脉压、心率和疼痛视觉模拟评分(VAS);记录手术和麻醉操作总时间、补救麻醉例数、手术医生对麻醉满意度及手术和麻醉相关并发症。结果TAPB联合RSB组和TAPB组T0~T3 VAS明显低于LA组[(1.92±0.95)和(3.00±1.08)分比(5.07±0.62)分、(1.31±0.63)和(2.54±0.66)分比(3.86±0.77)分、(0.85±0.69)和(1.77±0.93)分比(3.71±0.61)分、(1.38±0.77)和(1.38±0.87)分比(3.64±0.17)分],TAPB联合RSB组T1 VAS明显低于TAPB组,差异均有统计学意义(P<0.05)。三组各时间点平均动脉压和心率比较差异无统计学意义(P>0.05)。TAPB联合RSB组和TAPB组T0~T3手术医生对麻醉满意度均明显高于LA组[(3.12±0.76)和(3.11±0.65)分比(2.09±0.61)分、(3.09±0.82)和(2.68±0.75)分比(1.99±0.66)分、(3.35±0.82)和(3.31±0.75)分比(2.37±0.73)分、(3.02±0.82)和(3.01±0.75)分比(2.35±0.63)分],TAPB联合RSB组T1手术医生对麻醉满意度明显高于TAPB组,差异均有统计学意义(P<0.05)。LA组术中2例需要实施补救麻醉。TAPB联合RSB组手术和麻醉操作总时间明显短于TAPB组和LA组[(45.08±9.62)min比(74.46±7.29)和(69.71±13.25)min],LA组明显短于TAPB组,差异均有统计学意义(P<0.05)。三组均未观察到手术或麻醉相关并发症。结论采用mLS行TAPB联合RSB用于外科切开法PDC,术中麻醉效果确切,操作用时短,手术医生满意度高,血压和心率平稳,安全性高。Objective To explore the safety and effectiveness of modified lower costa surgical approach(mLS)for transversus abdominis plane block(TAPB)combined with rectus sheath block(RSB)in surgical incision peritoneal dialysis catheterization(PDC).Methods Forty chronic kidney disease of stage 5 patients scheduled for PDC from January to December 2018 in Huadu District People′s Hospital of Guangzhou City were selected.The patients were divided into 3 groups by random digits table method,among whom 13 cases used mLS for TAPB combined with RSB(TAPB combined with RSB group),13 cases used lateral approach combined with hip approach for TAPB(TAPB group),and 14 cases used local anesthesia(LA group).The mean arterial pressure,heart rate and pain visual analogue score(VAS)at skin incision(T0),separation of rectus abdominis(T1),peritoneal dialysis catheter placement(T2)and suture of skin and subcutaneous tunnel(T3)were recorded;and the total operation and anesthesia time,cases of rescue anesthesia,surgeon′s satisfaction with anesthesia,surgical and anesthesia related complication were recorded.Results The VAS from T0 to T3 in TAPB combined with RSB group and TAPB group was significantly lower than that in LA group:(1.92±0.95)and(3.00±1.08)scores vs.(5.07±0.62)scores,(1.31±0.63)and(2.54±0.66)scores vs.(3.86±0.77)scores,(0.85±0.69)and(1.77±0.93)scores vs.(3.71±0.61)scores,(1.38±0.77)and(1.38±0.87)scores vs.(3.64±0.17)scores,the VAS of T1 in TAPB combined with RSB group was significantly lower than that in TAPB group,and there were statistical differences(P<0.05).There were no statistical differences in mean arterial pressure and heart rate among 3 groups(P>0.05).The surgeon′s satisfaction with anesthesia from T0 to T3 in TAPB combined with RSB group and TAPB group were significantly higher than that in LA group:(3.12±0.76)and(3.11±0.65)scores vs.(2.09±0.61)scores,(3.09±0.82)and(2.68±0.75)scores vs.(1.99±0.66)scores,(3.35±0.82)and(3.31±0.75)scores vs.(2.37±0.73)scores,(3.02±0.82)and(3.01±0.75)scores vs.(2.

关 键 词：腹膜透析 麻醉 局部 神经传导阻滞 导管 留置 

分 类 号：R614[医药卫生—麻醉学]