腹横肌平面阻滞联合局部浸润麻醉在开腹式腹膜透析置管术中的应用  

Application of Transverse Abdominis Plane Block Combined with Local Infiltration Anesthesia in Open Peritoneal Dialysis Catheterization

作　　者：王艳[1] 拜雨炜 付丽娜[1] 高宇博[3] 陈娜[1] 阿胜[1] 马小琴[1] 张红霞[1] 倪新莉[3] 陈孟华[1] 田娜[1] WANG Yan;BAI Yuwei;FU Lina;GAO Yubo;CHEN Na;A Sheng;MA Xiaoqin;ZHANG Hongxia;NI Xinli;CHEN Menghua;TIAN Na(Department of Nephrology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Graduate School of Ningxia Medical University,Yinchuan 750004,China;Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肾脏内科,银川750004 [2]宁夏医科大学研究生院,银川750004 [3]宁夏医科大学总医院麻醉科,银川750004

出　　处：《宁夏医科大学学报》2021年第11期1130-1134,共5页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发项目(2018YBZD0031)。

摘　　要：目的评价腹横肌平面阻滞(TAPB)联合局部浸润麻醉在开腹式腹膜透析置管或重置术中的镇痛效果、安全性及不良反应。方法选择宁夏医科大学总医院2018年8月至2019年10月择期行腹膜透析置管术或重置术的55例终末期肾病(ESRD)患者,随机分为局部浸润麻醉组(L组)26例、TAPB联合局部浸润麻醉组(T组)29例。记录两组患者的人口学资料及术前临床指标,对比两组患者麻醉前0.5 h、切皮时刻及术后1 h时间点的血压和心率;术后即刻、术后12 h视觉模拟评分(VAS);同时比较两组术中和术后并发症发生情况。结果术前两组患者性别、年龄、BMI、原发病、合并症、血压及血生化指标差异均无统计学意义(P均>0.05)。L组患者切皮时刻及术后1 h的收缩压、舒张压及心率均高于麻醉前(P均<0.05);T组患者切皮时刻及术后1 h收缩压、舒张压及心率和麻醉前比较差异均无统计学意义(P均>0.05)。两组患者术前的收缩压、舒张压及心率差异均无统计学意义(P均>0.05),切皮时刻及术后1 h时L组患者的收缩压、舒张压及心率均高于T组(P均<0.05)。T组患者术后即刻及术后12 h的VAS疼痛评分均低于L组(P均<0.05)。T组在术后24 h使用镇痛药物的患者比例低于L组(P<0.05)。T组患者术后3 d内无穿刺部位感染、血肿、内脏损伤。两组患者术中发生恶心呕吐、眩晕、心悸气短及皮疹瘙痒的比例差异均无统计学意义(P均>0.05);1周内腹膜透析导管移位发生率差异无统计学意义(P>0.05)。结论超声引导下TAPB联合局麻应用于外科切开直视下腹膜透析导管置入术具有良好的术中及术后镇痛效果,且安全性良好。Objective To assess the effect,safety and adverse reactions of transverse abdominis plane block(TAPB)in peritoneal dialysis(PD)catheterization and re-catheterization by surgical laparotomy.Methods Patients with end-stage renal disease(ESRD)who underwent PD catheterization or re-catheterization were randomized to local infiltration anesthesia group(L group=26)and TAPB combined with local infiltration anesthesia group(T group=29).The following data were collected before the surgery:demographic data,clinical indexes.The following data were compared between the two groups(the blood pressure and heart rate)at three time points(half an hour before anesthesia,at the time of skin incision and 1 hour after operation).The visual analog score(VAS)was used to assess the pain degree of the two groups immediately after operation and 12 hours after operation.The associated complications were compared between the two groups.Results No significant differences were found in sex,age,BMI,primary disease,complications,blood pressure and blood biochemical indexes between the two groups before operation(P all>0.05).The blood pressure and heart rate at the time of skin incision and 1 hour after operation were much higher than before anesthesia in the L group,while not in T group(P all>0.05).There was no significant difference in systolic blood pressure,diastolic blood pressure and heart rate between the two groups before operation(P all>0.05).The blood pressure and heart rate at the time of skin incision and 1 hour after operation in L group were significantly increased than those in T group(P all<0.05).The VAS score of immediate and 12 hours after operation in T group were significantly lower than those in L group(P all<0.05).The patients taken analgesics in T group was significantly fewer than in L group at 24 h after operation(P<0.05).No cases of puncture site infection,hematoma and visceral injury were observed 3 days after operation in T group.No significant differences were found in the incidence of nausea,vomiting,vertigo,palpita

关 键 词：腹横肌平面阻滞 腹膜透析 腹膜透析置管术 视觉模拟评分 

分 类 号：R614.32[医药卫生—麻醉学] R459.5[医药卫生—外科学]