超声引导下腰方肌阻滞联合腹直肌鞘阻滞在腹膜透析管置入术中的应用  

Application of Ultrasound-Guided Quadratus Lumborum Block Combined with Rectus Sheath Block in Peritoneal Dialysis Catheter Implantation

作　　者：项霙 李丽伟[2] 尚进[3] 孙振涛[2] XIANG Ying;LI Liwei;SHANG Jin;SUN Zhentao(DepartmentⅡof Day Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Anesthesiology,Pain and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院日间手术部(2),河南郑州450000 [2]郑州大学第一附属医院麻醉与围术期医学部,河南郑州450000 [3]郑州大学第一附属医院肾脏内科,河南郑州450000

出　　处：《河南医学研究》2021年第33期6164-6167,共4页Henan Medical Research

摘　　要：目的观察超声引导下腰方肌阻滞联合腹直肌鞘阻滞在腹膜透析管置入术中的临床效果。方法选取2021年3—4月在郑州大学第一附属医院接受腹膜透析管置入术的40例患者作为研究对象,根据随机数字表法分为A、B两组,每组20例。A组接受超声引导下腰方肌阻滞联合腹直肌鞘阻滞麻醉,B组接受局部浸润麻醉。记录患者入室时(T_(0))、手术切皮时(T_(1))、分离腹直肌(T_(2))、置管(T_(3))及缝合腹壁(T_(4))时的平均动脉压(MAP)、心率(HR)以及视觉模拟评分(VAS);记录术中舒芬太尼追加例数;记录患者术后2、4、8、12、24 h VAS评分;记录术中、术后不良事件发生率,包括恶心、呕吐、便秘以及皮肤瘙痒。结果与T_(0)时间点比较,B组T_(1)~T_(4)各时间点MAP、HR均升高(P<0.05),两组T_(1)~T_(4)各时间点VAS评分均升高(P<0.05);与A组比较,B组T_(1)~T_(4)各时间点MAP、HR、VAS评分均升高(P<0.05),术中舒芬太尼追加例数增多(P<0.05)。与2 h比较,两组4、8、12 h VAS评分均升高,两组24 h VAS评分均降低(P<0.05);与4 h比较,A组24 h VAS评分降低,B组8 h VAS评分升高,12、24 h VAS评分降低(P<0.05);与8 h比较,A组24 h VAS评分降低,B组12、24 h VAS评分降低(P<0.05);与12 h比较,两组24 h VAS评分降低(P<0.05)。与A组比较,B组各时间点VAS评分升高(P<0.05)。B组术中术后呕吐、便秘发生率高于A组(P<0.05);B组不良事件总发生率高于A组(P<0.05)。结论超声引导下腰方肌阻滞联合腹直肌鞘阻滞在腹膜透析管置入术的应用效果较好,值得在临床推广。Objective To observe the clinical effect of ultrasound-guided quadratus lumborum block combined with rectus sheath block in peritoneal dialysis catheter implantation.Methods A total of 40 patients who accepted peritoneal dialysis catheter implantation surgery in the First Affiliated Hospital of Zhengzhou University from March to April 2021 were selected as the research objects.They were divide into group A and group B by random number table,with 20 cases in each group.Group A was treated with ultrasound-guided quadratus lumborum block combined with rectus sheath block,and group B was treated with local infiltration anesthesia.Mean arterial pressure(MAP),heart rate(HR)and visual analogue score(VAS)of the patients were recorded at the time of entering the operating room(T_(0)),surgical skin resection(T_(1)),separation of rectus abdominis(T_(2)),catheterization(T_(3))and suture of abdominal wall(T_(4)).Intraoperative sufentanil addition cases were recorded.VAS scores of postoperative 2,4,8,12 and 24 hours were recorded.The incidence of adverse events during and after surgery was recorded,including nausea,vomiting,constipation and itchy skin.Results Compared with T_(0),MAP and HR at each time point of T_(1)-T_(4) in group B were increased(P<0.05),and VAS scores at each time point of T_(1)-T_(4) in both groups were increased(P<0.05).Compared with group A,MAP,HR and VAS scores at each time point of T_(1)-T_(4) in group B were increased(P<0.05),and the number of cases of sufentanil addition in group B was increased(P<0.05).Compared with 2 hours,the 4,8 and 12 hours VAS scores of two groups were increased,and the 24 hours VAS scores of two groups were decreased(P<0.05).Compared with 4 hours,the 24 hours VAS score of group A was decreased and the 8 hours VAS score of group B was increased,and the 12 and 24 hours VAS scores were decreased(P<0.05).Compared with 8 hours,the 24 hours VAS score of group A was decreased,and the 12 and 24 hours VAS scores of group B were decreased(P<0.05).Compared with 12 hours,24 hours VAS scor

关 键 词：超声引导 腰方肌阻滞 腹直肌鞘阻滞 腹膜透析管置入 

分 类 号：R614.3[医药卫生—麻醉学]