超声引导下竖脊肌阻滞在同种异体肾移植术中的应用  

Application of ultrasound-guided erector spinae plane block in patients undergoing allogeneic renal transplantation

作　　者：王璇 王敏 田蜜 刘芳芳 WANG Xuan;WANG Min;TIAN Mi;LIU Fangfang(Department of Anesthesiology,General Hospital of Eastern Theater Command,Nanjing 210002;College of Anesthesiology,XuzhouMedical University,Xuzhou Jiangsu 221004;Department of Anesthesiology,Women’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]东部战区总医院麻醉科,南京210002 [2]徐州医科大学麻醉学院,江苏徐州221004 [3]南京医科大学附属妇产医院,南京市妇幼保健院麻醉科,南京210004

出　　处：《临床与病理杂志》2022年第4期905-910,共6页Journal of Clinical and Pathological Research

摘　　要：目的:探讨超声引导下竖脊肌平面(erector spinae plane,ESP)阻滞在同种异体肾移植术中的应用效果。方法:择期选取同种异体肾移植患者60例,ASA Ⅲ级,随机均分为ESP阻滞组(E组)与对照组(C组)。E组患者于全麻诱导后行超声引导下ESP阻滞,C组不进行此项操作。2组患者术后均采用静脉自控镇痛泵镇痛。记录2组患者的手术时间、麻醉药用量、拔管时间、镇痛泵的按压次数、睡眠满意度、术后躁动和苏醒延迟发生例数;记录2组患者在术前(T0)、麻醉开始后30 min(T1)、手术结束后30 min(T2)的心率(heart rate,HR)和平均动脉压(mean arterial pressure,MAP);比较患者术后12 h(T3)、24 h(T4)、48 h(T5)静息状态下的视觉模拟量表(Visual Analogue Scale,VAS)评分。结果:2组患者一般资料和手术时间的差异无统计学意义,但与C组相比,E组患者麻醉药用量、各时间段的VAS评分和术后48 h内镇痛泵按压次数均明显减少(P<0.05)。各时间段的生命体征,E组在T2的HR和MAP明显低于C组(P<0.05),术后拔管时间、躁动及苏醒延迟发生率明显低于C组,睡眠满意度评分显著高于C组(P<0.05)。结论:同种异体肾移植术中应用超声引导下ESP阻滞既可减轻术后疼痛程度,提高睡眠满意度,又可减少阿片类药物的使用,减轻不良反应,值得临床推广应用。Objective: To observe the effects on patients undergoing allogeneic renal transplantation using ultrasound-guided erector spinae plane(ESP) block. Methods: A total of sixty patients of ASA Ⅲ grade, who were scheduled for allogeneic renal transplantation, were randomly divided into an ultrasound-guided ESP group(group E) and a control group(group C). Group E received ultrasound-guided ESP block a?ter general anesthesia, while group C did not receive this procedure. Patients in both groups were treated with intravenous patient-controlled analgesia(PCA) a?ter the surgery. Operation time, general anesthetics consumptions, extubation time, times of pressing PCA regimen,sleep satisfaction, postoperative agitation, and the rate of delayed revive were all recorded respectively. Heart rate(HR) and mean arterial pressure(MAP) were recorded before the surgery(T0), 30 min a?ter anesthesia(T1), and 30 min a?ter operation(T2);meanwhile, Visual Analogue Scores(VAS) in resting status at 12 h(T3), 24 h(T4), and 48 h(T5) a?ter the surgery were compared. Results: There was no difference in general information and operation time between the two groups. But compared with the group C, the consumption of anesthetics, the VAS score of each time period, and the number of analgesic pump compressions within 48 hours a?ter the surgery were significantly reduced in the group E(P<0.05). For vital signs at each point of time, the HR and MAP of group E at T2 were significantly lower than those of the group C(P<0.05). The postoperative extubation time, restlessness and delayed wake-up rates were also significantly lower than those of the group C. Sleep satisfaction scores were also significantly higher than those of the group C(P<0.05). Conclusion: The application of ultrasound-guided erector spinal muscle plane block in allogeneic kidney transplantation can reduce both postoperative pain, and opioids consumption. It can also improve the sleep satisfaction scores and reduce adverse reactions. It is preferable for clinical application.

关 键 词：超声引导下竖脊肌阻滞 同种异体肾移植 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]