肋间神经阻滞超前镇痛联合切口浸润麻醉用于腹腔镜胆囊切除术后的效果评价  

Evaluation of the effect of intercostal nerve block preemptive analgesia combined with incision infiltration anesthesia in laparoscopic cholecystectomy

作　　者：胥彬 潘冬花 兰春斌 徐竹林 刘贤 李贵全[1] XU Bin;PAN Dong-hua;LAN Chun-bin;XU Zhu-lin;LIU Xian;LI Gui-quan(Department of General Surgery, Qionglai Medical Center Hospital, Qionglai 611530, China)

机构地区：[1]四川省邛崃市医疗中心医院普外一科,四川邛崃611530

出　　处：《实用医院临床杂志》2022年第4期92-95,共4页Practical Journal of Clinical Medicine

基　　金：成都市卫生健康委员会科研课题(编号2019084)。

摘　　要：目的探讨超声引导下肋间神经阻滞超前镇痛联合长效麻醉剂切口浸润麻醉在腹腔镜胆囊切除术后镇痛的临床疗效。方法纳入2019年7月至2020年2月189例在我科行腹腔镜胆囊切除的患者。试验组95例,采用术前超声引导下0.2%罗哌卡因行双侧第9、10、11组肋间神经阻滞麻醉及术后各切口0.2%罗哌卡因分层浸润麻醉。对照组94例仅行0.2%罗哌卡因切口分层浸润麻醉。比较两组术后疼痛VAS评分、并发症、需要补救性镇痛等情况。结果术后2 h,两组静息VAS比较,差异无统计学意义(P>0.05);术后4、8、12、24及48 h,试验组静息VAS较对照组低(P<0.05);术后8、24及48 h试验组活动后VAS低于对照组(均P<0.05)。试验组补救性镇痛的比例低于对照组(P<0.05)。两组患者在术后并发症方面比较差异无统计学意义(P>0.05)。结论超声引导下肋间神经阻滞联合长效麻醉剂切口浸润麻醉在腹腔镜胆囊切除术后镇痛安全、可行,有效减轻术后疼痛,值得进一步研究。Objective To investigate the efficacy of ultrasound-guided intercostal nerve block preemptive analgesia combined with long-acting anesthetic incision infiltration anesthesia in postoperative analgesia after laparoscopic cholecystectomy(LC).Methods 189 patients undergoing LC in our centre from July 2019 to February 2020 were selected.In the experimental group,preoperative ultrasound-guided 0.2%ropivacaine was used for bilateral 9th,10th,and 11th intercostal nerve block anesthesia,and for layered infiltration of each incision after operation.In the control group,only layered infiltration of each incision after operation was performed.Visual analogue scale(VAS),complications,and supplementary analgesia were compared between the two groups.Results After 2 hours of operation,there was no significant difference in the sedation VAS score between the two groups(P>0.05).The sedation VAS scores in the experimental group were lower after 4,8,12,24 and 48 hours of operation than those in the control group(all P<0.05).The exercise VAS scores in the experimental group were lower than those in the control group after 8,24 and 48 hours(all P<0.05).The requirement for postoperative rescue analgesics was lower in the experimental group than that in the control group(P<0.05).There was no difference in postoperative complications between the two groups.Conclusion Ultrasound-guided intercostal nerve block preemptive analgesia combined with long-acting anesthetic incision infiltration anesthesia is safe and feasible.It reduces the postoperative pain.It is worth further research.

关 键 词：术后镇痛 肋间神经阻滞 切口浸润麻醉 腹腔镜胆囊切除术 

分 类 号：R614[医药卫生—麻醉学]