复方盐酸利多卡因TAP-RSB用于腹腔镜结肠癌根治术全麻老年患者术后镇痛的量效关系  

Dose-effect relationship of compound lidocaine hydrochloride for TAP-RSB for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia

作　　者：张卓 马浩南[2] 张麟临 孙健[4] 余剑波[1] Zhang Zhuo;Ma Haonan;Zhang Linlin;Sun Jian;Yu Jianbo(Tianjin Nankai Hospital,Tianjin Medical University,Tianjin 300100,China;Department of Anesthesiology,Tianjin TEDA Hospital(TEDA Hospital of Tianjin University),Tianjin 300457,China;Department of Anesthesiology,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Anesthesiology,The Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学南开临床学院,天津300100 [2]天津市泰达医院(天津大学泰达医院)麻醉科,天津300457 [3]天津医科大学总医院麻醉科,天津300052 [4]天津医科大学第二医院麻醉科,天津300211

出　　处：《中华麻醉学杂志》2022年第5期572-575,共4页Chinese Journal of Anesthesiology

摘　　要：方法择期行腹腔镜结肠癌根治术老年患者,性别不限,年龄≥65岁,BMI<30 kg/m^(2),ASA分级Ⅰ~Ⅲ级。全麻诱导后在超声引导下行复方盐酸利多卡因双侧TAPB(每侧注药20 ml)和双侧RSB(每侧注药10 ml),起始浓度为0.4%,镇痛无效则下一例患者提高1个浓度梯度,镇痛有效则下一例患者降低1个浓度梯度,相邻浓度比值为1.00∶1.15。术后进入苏醒室起至TAP-RSB后8 h内,每隔1 h以数字疼痛评价量表(NRS)评价镇痛效果(NRS≤3分为镇痛有效)。采用Probit法计算复方盐酸利多卡因半数有效浓度(EC_(50))和95%有效浓度(EC_(95))及其95%置信区间。结果复方盐酸利多卡因TAP-RSB用于腹腔镜结肠癌根治术全麻老年患者术后镇痛的EC_(50)、EC_(95)及其95%置信区间为0.289%(0.232%~0.352%)和0.404%(0.345%~0.970%)。结论复方盐酸利多卡因TAP-RSB用于腹腔镜结肠癌根治术全麻老年患者术后镇痛的EC_(50)和EC_(95)为0.289%和0.404%。Objective To evaluate the dose-effect relationship of compound lidocaine hydrochloride for transverse abdominal plane-rectus abdominis sheath block(TAP-RSB)for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.Methods Elderly patients of either sex,aged≥65 yr,with body mass index<30 kg/m^(2),of American Society Anesthesiologists physical statusⅠ-Ⅲ,undergoing elective laparoscopic radical colon cancer surgery with general anesthesia,were selected.After induction of general anesthesia,compound lidocaine hydrochloride was given under ultrasound guidance for bilateral TAP block(20 ml on each side)and for bilateral RSB(10 ml on each side),with the initial concentration of 0.4%.Each time the concentration increased/decreased in the next patient depending on whether or not the analgesia was effective.The ratio between the two successive concentrations was 1.00∶1.15.The analgesic effects were evaluated by the Numerical Rating Scale at 1 h intervals from the time of postoperative admission to the post-anesthesia care unit until 8 h after TAP-RSB(Numerical Rating Scale≤3 was considered as effective analgesia).The probit method was used to calculate the half effective concentration(EC_(50))and 95%effective concentration(EC_(95))and 95%confidence interval of compound lidocaine hydrochloride.Results The EC_(50) and EC_(95)(95%confidence interval)of compound lidocaine hydrochloride for TAP-RSB were 0.289%(0.232%-0.352%)and 0.404%(0.345%-0.970%),respectively,when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.Conclusions The EC_(50) and EC_(95) of compound lidocaine hydrochloride for TAP-RSB are 0.289%and 0.404%,respectively,when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.

关 键 词：利多卡因 腹肌 腹直肌 神经传导阻滞 腹腔镜检查 结肠癌 麻醉 全身 老年人 镇痛 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]