超声引导椎旁阻滞在机器人辅助肾切除手术中的应用  

Application of ultrasound-guided paravertebral block inrobot-assisted nephrectomy

作　　者：殷国江 李月 阮剑辉 李坤 甘国胜 黎笔熙 宋晓阳 YIN Guojiang;LI Yue;RUAN Jianhui;LI Kun;GAN Cuosheng;LI Bixi;SONG Xiaoyang(Department of Anesthesiology,General Hospital of the PLA Central Theater Command,Wuhan 430070,China)

机构地区：[1]中国人民解放军中部战区总医院麻醉科,武汉430070

出　　处：《实用医学杂志》2022年第2期196-200,共5页The Journal of Practical Medicine

摘　　要：目的评估超声引导胸、腰段椎旁阻滞对机器人辅助肾切除手术患者围术期镇痛效果及术后早期恢复质量的影响。方法选择择期全麻下行机器人辅助腹腔镜肾切除手术患者80例,随机分为观察组和对照组,每组40例,观察组行椎旁阻滞后全麻,对照组单纯全麻。记录不同时间点的MAP和HR;记录术中瑞芬太尼用量,呼之睁眼、呼吸恢复、拔管及出室时间,麻醉苏醒期Ricker镇静-躁动评分(SAS)及VAS评分;记录术后不同时间点的VAS评分;记录患者术前1 d、术后1 d及术后2 d时的术后恢复质量量表(QoR-40)评分;记录术后镇痛泵有效按压、补救镇痛及相关不良反应的发生情况。结果与对照组比较,观察组MAP及HR更加平稳(P <0.05);术中瑞芬太尼用量更少,患者呼之睁眼、呼吸恢复、拔管及出室时间更短,麻醉苏醒期SAS及VAS评分更低(P <0.05);术后6、12及24 h静息及咳嗽时VAS评分更低(P <0.05);术后1 d时的QoR-40量表各项目评分及总分均更高(P <0.05),术后2 d时的QoR-40量表中身体舒适度、情绪状态、行为独立及总分更高(P <0.05)。结论胸、腰段椎旁阻滞可为机器人辅助腹腔镜肾切除手术提供较好的围术期镇痛,有助于术后早期恢复。Objective To evaluate the effects of ultrasound-guided thoracic and lumbar paravertebral block on the perioperative analgesia and early postoperative recovery in patients undergoing robot-assisted nephrectomy. Methods Eighty patients receiving elective robot-assisted laparoscopic nephrectomy were randomly divided into two groups with 40 patients in each group. The observation group was performed under general anesthesia after paravertebral block,and the control group was performed under general anesthesia. MAP and HR at different time points were recorded. The intraoperative dosage of remifentanil,eye opening time,respiratory recovery time,extubation time,exiting room time,Ricker sedation-agitation score(SAS)and VAS score during anesthesia recovery were recorded. The resting and coughing VAS scores at different time points postoperatively were recorded. The postoperative quality of recovery(QoR-40)scores at 1 day before surgery,1 day after surgery and 2 days after surgery were recorded. The incidence of effective pressure of postoperative analgesia pump,remedial analgesia,and related adverse reactions were recorded. Results Compared with the control group,MAP and HR in the observation group were more stable(P < 0.05). The amount of intraoperative remifentanil in the observation group was significantly reduced,the SAS score and VAS score during anesthesia recovery period in the observation group was lower,the time of eye opening,respiratory recovery,extubation and exit from the room were shorter in the observation group(P < 0.05). The resting and coughing VAS scores of the observation group at 6 h,12 h and 24 h after surgery were significantly lower(P < 0.05). The scores of all items and total scores of QoR-40 scale in observation group increased at 1 d after surgery(P < 0.05),physical comfort,emotional state,behavioral independence and total score of QoR-40 scale increased at 2 d after surgery(P < 0.05). Conclusion Thoracic and lumbar paravertebral block could provide better perioperative analgesia for robot-assi

关 键 词：超声引导 椎旁阻滞 达芬奇机器人 恢复质量 围术期镇痛 

分 类 号：R614[医药卫生—麻醉学]