超声引导TAP阻滞、ESP阻滞对原位肝移植患者术后镇痛的效果观察  

Effects of ultrasound-guided TAP block and ESP block on postoperative analgesia in patients undergoing orthotopic liver transplantation

作　　者：伍辉萍[1] 欧伟明[1] 梁桦[1] 周桥灵[1] 廖美娟[1] 徐枫[1] 冯舒韵[1] Wu Huiping;Ou Weiming;Liang Hua;Zhou Qiaoling;Liao Meijuan;Xu Feng;Feng Shuyun(Department of Anesthesiology,Foshan First People's Hospital,Foshan 528000,Guangdong,China)

机构地区：[1]佛山市第一人民医院麻醉科,广东佛山528000

出　　处：《实用器官移植电子杂志》2022年第2期117-121,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：佛山市卫生健康局医学科研课题(20200207)。

摘　　要：目的 比较术前超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)或竖脊肌平面阻滞(erector spinae plane block,ESPB)联合病人自控静脉镇痛(patient controlled intravenous analgesia,PCIA)对原位肝移植患者术后镇痛的应用效果。方法 选取45例行改良背驮式原位肝移植术患者,年龄为18~64岁,体重身高指数(body mass index,BMI)为18~24 kg/m^(2),ASA分级为Ⅲ~Ⅴ级,分为3组(n=15):术前TAPB组、术前ESPB组和常规PCIA镇痛组(C组)。TAPB组在全麻诱导后经B超引导下行双侧肋缘下入路两点腹横肌平面阻滞,每点注入混合药液(0.33%罗哌卡因30 ml+地塞米松5 mg)15 ml。ESPB组在全麻诱导后经B超引导下行双侧T7水平竖脊肌平面阻滞,每侧注入混合药液(0.33%罗哌卡因30 ml+地塞米松5 mg)30 ml。C组为常规PCIA镇痛组,术前不行神经阻滞。三组术后均使用舒芬太尼2μg/kg PCIA镇痛泵,若术后48 h内疼痛评分VAS≤3分,予静脉单次追加舒芬太尼5μg行补救镇痛。记录术中瑞芬太尼用量和拔除气管导管时间。观察术后48 h内舒芬太尼补救镇痛用量、恶心呕吐、皮肤瘙痒和呼吸抑制的发生情况。结果 与C组比较,TAPB组和ESPB组术中瑞芬太尼及术后补救镇痛舒芬太尼用量均减少,拔除气管导管时间缩短,术后不良反应发生率降低(P <0.05)。ESPB组和TAPB组比较,术中瑞芬太尼用量、术后48 h内舒芬太尼补救镇痛用量减少(P <0.05),拔除气管导管时间、术后不良反应发生率均无统计学差异(P> 0.05)。结论 术前超声引导TAPB或ESPB联合PCIA静脉镇痛对原位肝移植手术患者均能提供良好的镇痛效果,不良反应少,与TAPB相比,ESPB静脉镇痛药物的用量少。Objective To evaluate the effect of preoperative B-ultrasound-leaded transversus abdominis plane block(TAPB)or erector spinae plane block(ESPB)combining with patient controlled intravenous analgesia(PCIA)on postoperative analgesia in patients undergoing orthotopic liver transplantation.Methods Forty-five patients with modified piggy-back orthotopic liver transplantation were selected.The aged was 18~64 years old.The body mass index was 18~24 kg/m^(2),and the ASA grade wasⅢ~Ⅴ.They were divided into 3 groups(n=15):preoperative TAPB group,preoperative ESPB group and regular PCIA group(C group).In the TAPB group,after the induction of general anesthesia,ultrasound-guided two-step TAPB was performed under the bilateral costal approach.Each point was injected with a mixture drug 15 ml(0.33%ropivacaine 30 ml+dexamethasone 5 mg).In the ESPB group,after the induction of general anesthesia,ultrasound-guided bilateral TAPB was performed in T7.Each point was injected with a mixture drug 30 ml(0.33%ropivacaine 30 ml+dexamethasone 5 mg).Group C was a conventional general anesthesia group,no nerve block was performed.Sufentanil 2μg/kg PCIA was used in every groups,and the visual analog scale score(VAS)was maintained≤3 within 48 h after operation.Sufentanil 5μg was intravenously injected as rescue analgesic.The intraoperative consumption of remifentanil and the requirement for sufentanil as rescue analgesic were recorded.The extubation time after operation and development of nausea,vomiting,itching and respiratory depression were recorded within 48 h after surgery.Results Compared with group C,the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were both decreased in TAPB and ESPB groups.Also the time of extubation was shortened,and the adverse reactions were decrecing within two days after operation(P<0.05).Compared with group TAPB,the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were decreased

关 键 词：腹横肌平面阻滞 竖脊肌平面阻滞 肝移植 疼痛 

分 类 号：R614[医药卫生—麻醉学]