超声引导下低浓度罗哌卡因低位前锯肌平面复合腹直肌鞘阻滞用于开腹胃手术术后镇痛的效果  

Effect of Low Concentration Ropivacaine Low Anterior Serratus PlaneCombined with Rectus Abdominis Sheath Block on PostoperativeAnalgesia after Open Stomach Surgery

作　　者：陈晓阳 蔡松波 张德应 Chen Xiaoyang(Department of Anesthesiology,Huidong people’s Hospital,Huidong Huizhou Guangdong 516300)

机构地区：[1]惠东县人民医院麻醉科,广东惠州惠东516300

出　　处：《黑龙江医药》2023年第1期35-38,共4页Heilongjiang Medicine journal

基　　金：惠州市科技计划项目(编号:2021WC0106049)。

摘　　要：目的:本研究旨在探讨超声引导下低浓度罗哌卡因低位前锯肌平面复合腹直肌鞘阻滞用于开腹胃手术术后镇痛的效果。方法:选择2018年4月至2021年8月在惠东县人民医院接受择期气管插管全身麻醉下开腹胃手术患者60例,随机分为N组和E组,每组30例。两组患者均实施标准化气管插管全身麻醉方案,N组患者麻醉前实施超声引导下低位前锯肌平面复合腹直肌鞘阻滞,术后行连续静脉自控镇痛。E组患者麻醉前实施T8~T9硬膜外间隙置管,术后行连续硬膜外自控镇痛。比较两组患者术中丙泊酚、瑞芬太尼使用量和血管活性药物如麻黄碱、间羟胺使用例数;比较两组患者术后4、8、12、24、48h疼痛VAS评分;比较两组患者术后48h内下床活动总次数和镇痛泵按压次数;比较两组患者术后不良反应发生情况。 结果: N组患者血管活性药物使用例数明显低于E组( P <0.05),两组患者术中丙泊酚、瑞芬太尼使用量比较差异无统计学意义( P >0.05),两组患者术后4h、8h、12h、24h、48h疼痛VAS评分比较差异无统计学意义( P >0.05),N组患者术后48h内下床活动总次数明显高于E组( P <0.05),两组患者术后48h内镇痛泵按压次数比较差异无统计学意义( P >0.05),N组患者术后低血压发生率明显低于E组( P <0.05),两组患者术后恶心呕吐、尿潴留、眩晕发生率比较差异无统计学意义( P >0.05)。 结论: 超声引导低位前锯肌平面阻滞、腹直肌鞘阻滞联合静脉镇痛能为开腹胃手术患者提供良好术后镇痛,与连续硬膜外镇痛方法相当,但镇痛期间血流动力学更稳定,血管活性药物使用例数更少。Objective:The purpose of this study was to investigate the effect of low concentration ropivacaine low anterior serratus plane combined with rectus abdominis sheath block on postoperative analgesia after open stomach surgery.Methods:From April 2018 to August 2021,60 patients who underwent elective endotracheal intubation under general anesthesia in Huidong County People’s hospital were randomly divided into group N and group E,with 30 patients in each group.Corresponding nerve block and intravenous analgesia were performed in group N,and epidural block and analgesia were performed in group E.The analgesic effect and incidence of adverse reactions were compared between the two groups.Results:The use of vasoactive drugs in group N was significantly lower than that in Group E(P<0.05).There was no significant difference in the use of propofol and remifentanil between the two groups(P>0.05).There was no significant difference in pain VAS scores at 4h,8h,12h,24h and 48h after operation between the two groups(P>0.05),The total number of ambulation activities of 48h in group N was significantly higher than that in group E(P<0.05).There was no significant difference in the frequency of analgesia pump in the two groups after operation(P>0.05).The incidence of hypotension in N group was significantly lower than that in E group(P<0.05).There was no significant difference in incidence of postoperative nausea and vomiting,urinary retention and vertigo between two groups(P>0.05).Conclusion:Ultrasound guided low anterior serratus plane block,rectus sheath block combined with intravenous analgesia can provide good postoperative analgesic effect for patients undergoing open stomach surgery,which is equivalent to continuous epidural analgesia,but the hemodynamics is more stable during analgesia and the number of cases of vasoactive drugs is less.

关 键 词：超声 神经阻滞 开腹胃手术 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]