术前肋间神经阻滞对后腹腔镜肾切除术患者围术期应激反应的影响  

Effect of preoperative intercostal nerve block on perioperative stress response in patients undergoing retroperitoneal laparoscopy nephrectomy

作　　者：郑腊梅 吕容 汪同旋 魏闯 ZHENG Lamei;LYU Rong;WANG Tongxuan;WEI Chuang(Department of Anesthesiology,Cancer Hospital Chongqing University,Chongqing 400000,China)

机构地区：[1]重庆大学附属肿瘤医院麻醉科,400000

出　　处：《重庆医学》2023年第5期720-723,共4页Chongqing medicine

基　　金：中央(财政部和科技部)领导地方科技发展专项[渝财规(2016)5号]。

摘　　要：目的探讨术前肋间神经阻滞对择期行后腹腔镜肾切除术患者围术期应激反应的影响。方法选取2020年1-8月该院收治的40例后腹腔镜肾切除术患者为研究对象,分为试验组和对照组,每组20例。试验组术前给予0.375%罗哌卡因+地塞米松10 mg+吗啡2 mg(总体积20 mL)阻滞腋后线第8~12胸椎(T8~T12)神经,对照组给予20 mL生理盐水。随后两组于全身麻醉下行后腹腔镜肾切除术,比较两组肾上腺素(E)、去甲肾上腺素(NE)浓度、皮质醇(COR)及白细胞介素(IL)-6、IL-10水平变化,以及术中使用的镇痛药剂量、术后镇痛泵按压次数、术后镇痛药使用剂量、术后肺部并发症发生情况。结果气腹建立后及关腹时,两组E、NE、COR水平较术前升高,试验组低于对照组(P<0.05)。术后24 h两组E、NE水平基本恢复,且COR水平低于术前(P<0.05)。术后24 h两组IL-6、IL-10水平较术前升高(P<0.05),但两组间比较差异无统计学意义(P>0.05)。与对照组比较,试验组舒芬太尼和吗啡用量更少,术后镇痛泵第1次按压时间更长,72 h内按压次数更少,差异有统计学意义(P<0.05)。试验组发生肺不张5例(25.0%),对照组12例(60.0%)。结论术前肋间神经阻滞能降低术中应激反应并减少镇痛药物使用。Objective To investigate the effect of postoperative intercostal nerve block on perioperative stress response in patients undergoing elective retroperitoneal laparoscopic nephrectomy.Methods A total of 40 patients with retroperitoneal laparoscopic nephrectomy admitted to this hospital from January to August 2020 were selected as the research objects and divided into the experimental group and the control group,with 20 cases in each group.The experimental group was given 0.375%ropivacaine+dexamethasone ten mg+morphine two mg(total volume 20 mL)to block the 8th thoracic vertebra(T8)to 12th thoracic vertebra(T12)nerves in the posterior axillary line before surgery,and the control group was given 20 mL normal saline.Then the two groups underwent retrolaparoscopic nephrectomy under general anesthesia.The concentrations of epinephrine(E),norepinephrine(NE),cortisol(COR),interleukin(IL)-6 and IL-10 were compared between the two groups,as well as the amount of analgesics used during the operation,the number of postoperative analgesic pump pressure,the dose of postoperative analgesics and the incidence of postoperative pulmonary complications.Results After the establishment of pneumoperitoneum and closing the abdominal cavity,the levels of E,NE,and COR in the two groups were higher than those before operation,and the experimental group was lower than the control group(P<0.05).At 24 hours after operation,E and NE in the two groups were basically recovered,and COR level was even lower than that before operation(P<0.05).At 24 h after operation,the levels of IL-6 and IL-10 in the two groups were higher than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Compared with the control group,the dosage of sufentanil and morphine in the experimental group was lower,the first postoperative analgesia pump was longer,and the number of postoperative analgesia pump was less within 72 hours,the differences were statistically significant(P<0.05).There are 5 cases(25.0%)atelectasis in th

关 键 词：肋间神经阻滞 应激反应 肾上腺素 去甲肾上腺素 皮质醇 肺不张 

分 类 号：R614[医药卫生—麻醉学]