静脉麻醉诱导联合前腰方肌阻滞对腹膜后入路肾部分切除术患者的镇痛效果及血流动力学的变化  

Analgesic effect of intravenous anesthesia induction combined anterior lumbar quadratus block and related hemodynamic changes in patients undergoing partial nephrectomy via retroperitoneal approach

作　　者：袁海军[1] 黄晓霞[1] 蓝志坚[1] 傅理[1] 彭文勇[1] 傅亚明 Haijun Yuan;Xiaoxia Huang;Zhijian Lan;Li Fu;Wenyong Peng;Yaming Fu(Department of Anesthesiology,Jinhua Central Hospital,Jinhua 321000,China;Department of Psychiatry,Jinhua Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院麻醉科,金华321000 [2]金华市中心医院精神科,金华321000

出　　处：《中华全科医师杂志》2022年第11期1063-1068,共6页Chinese Journal of General Practitioners

基　　金：2020浙江省医药卫生科技计划(2020KY345);2021年度公益类金华市科学技术研究计划项目(2021-4-006)。

摘　　要：目的了解静脉麻醉诱导联合前腰方肌阻滞对腹腔镜腹膜后入路肾部分切除术患者的镇痛效果及血流动力学的影响。方法选取2021年8月至2022年2月金华市中心医院116例择期行腹腔镜肾肿瘤肾部分切除术患者为研究对象,其中男性65例、女性51例,年龄42~64岁。采用抽签法将116例患者分为对照组和观察组(各58例),分别行静脉麻醉、静脉麻醉诱导联合前腰方肌阻滞下腹膜后入路肾部分切除术。采用疼痛视觉模拟评分(VAS)于术后1、6、12、24和48 h观察镇痛效果;以心率和平均动脉压(MAP)观察入手术室时(T_(0))、麻醉诱导后3 min(T_(1))、手术开始时(T_(2))、术毕(T_(3))、出手术室时(T_(4))血流动力学表现;采用管襻形态积分、血液流态积分观察术后1、6、12、24和48 h的微循环改变;采用简易智力状态检查量表(MMSE)于麻醉前30 min、术后6、24和72 h进行认知功能评定,并进行两组比较。结果术后1、6、12、24和48 h,观察组静息时(平躺安静状态下)VAS分别为(3.2±1.2)、(2.6±0.3)、(2.0±0.4)、(1.5±0.4)和(0.8±0.2)分,低于对照组的(4.0±1.7)、(3.4±0.7)、(2.9±0.5)、(1.7±0.5)和(1.2±0.3)分,差异均有统计学意义(t=2.93,P=0.004;t=8.00,P<0.001;t=10.07,P<0.001;t=2.38,P=0.019;t=8.45,P<0.001)。观察组与对照组T0时的心率和MAP比较,差异无统计学意义;T1、T2、T3、T4时心率比较差异均无统计学意义,MAP水平[观察组分别为(80.0±8.0)、(84.4±8.4)、(80.4±5.7)和(86.4±4.7)mmHg(1 mmHg=0.133 kPa),对照组为(77.1±7.5)、(88.0±8.6)、(83.0±7.7)和(92.2±6.2)mmHg]比较,差异均有统计学意义(t=2.01,P=0.046;t=2.28,P=0.024;t=2.07,P=0.041;t=5.68,P<0.001)。术后6、12、24和48 h,观察组管襻形态积分分别为(1.0±0.2)、(0.8±0.2)、(0.7±0.1)和(0.7±0.1)分,低于对照组的(1.1±0.2)、(0.9±0.2)、(0.8±0.2)和(0.8±0.1)分,差异均有统计学意义(t=2.69,P=0.008;t=2.69,P=0.008;t=3.41,P=0.001;t=5.39,P<0.001);血液流态积分分别为(1Objective To investigate the analgesic effect of intravenous anesthesia induction combined with anterior quadratus lumborum block(AQLB)and related hemodynamic changes in patients undergoing laparoscopic retroperitoneal partial nephrectomy(RPN).Methods A total of 116 patients undergoing elective laparoscopic partial nephrectomy for renal tumors in Jinhua Central Hospital from August 2021 to February 2022 were randomly divided into two groups with 58 cases in each group.Patients in control group received intravenous anesthesia,while those in study group received intravenous anesthesia induction with AQLB.The analgesic effect was evaluated at 1,6,12,24,and 48 h after the operation.The hemodynamics were monitored at the time of entering the operating room(T_(0)),3 min after induction of anesthesia(T_(1)),at the beginning of the operation(T_(2)),after the operation(T_(3)),and leaving the operating room(T_(4)).Microcirculation was assessed at 1,6,12,24,and 48 h after operation.Cognitive function was assessed 30min before anesthesia,6 h,24 h,and 72 h after operation.Results At 1,6,12,24 and 48 h after operation,the visual analogue scale(VAS)of the resting(quiet state)pain in the study group were 3.2±1.2,2.6±0.3,2.0±0.4,1.5±0.4 and 0.8±0.2,which were significantly lower than those in control group(4.0±1.7,3.4±0.7,2.9±0.5,1.7±0.5 and 1.2±0.3)(t=2.93,P=0.004;t=8.00,P<0.001;t=10.07,P<0.001;t=2.38,P=0.019;t=8.45,P<0.001).There was no significant difference in heart rate and mean arterial pressure(MAP)at T0 between two groups;no significant difference in the heart rate at T1,T2,T3 and T4.There were significant differences in MAP levels at T1,T2,T3 and T4 between study group[(80.0±8.0)mmHg(1 mmHg=0.133 kPa),(84.4±8.4)mmHg,(80.4±5.7)mmHg,(86.4±4.7)mmHg and control group(77.1±7.5)mmHg,(88.0±8.6)mmHg,(83.0±7.7)mmHg,(92.2±6.2)mmHg;t=2.01,P=0.046;t=2.28,P=0.024;t=2.07,P=0.041;t=5.68,P<0.001].At 6,12,24 and 48 h after operation,the morphological scores of tube loops in the study group were 1.0±0.2,0.8±0.2,0.7±0.

关 键 词：麻醉 静脉 神经肌肉阻滞 前腰方肌 肾切除术 部分性 镇痛 血流动力学 

分 类 号：R699.2[医药卫生—泌尿科学]