超声引导下胸椎旁神经阻滞联合腰方肌阻滞在经皮肾镜碎石术中的应用  

Application of ultrasound-guided thoracic paravertebral nerve block combined with quadratuslumborum block in percutaneous nephrolithotripsy

作　　者：吴召召 叶青山[1] 马增瑞 王云 黑云鹏 丁冠博 高巍 李丽 张亦驰 刘文勋[1] WU Zhaozhao;YE Qingshan;MA Zengrui;WANG Yun;HEI Yunpeng;DING Guanbo;GAO Wei;LI Li;ZHANG Yichi;LIU Wenxun(Department of Anesthesiology,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Department of Infornation,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院麻醉科,宁夏银川750002 [2]宁夏回族自治区人民医院信息科,宁夏银川750002

出　　处：《宁夏医学杂志》2023年第10期901-904,共4页Ningxia Medical Journal

基　　金：宁夏卫生健康科研课题资助项目(202010);宁夏自然科学基金资助项目(2023AAC03474)。

摘　　要：目的 探讨超声引导下的胸椎旁神经阻滞联合腰方肌阻滞在经皮肾镜碎石术中的麻醉效果。方法 选取行经皮肾镜碎石术的患者60例作为研究对象,随机分为超声引导下胸椎旁神经阻滞组和超声引导下胸椎旁神经阻滞联合腰方肌阻滞组各30例。TPVB组(简称T组)为超声引导下胸椎旁神经阻滞组;TPVB+QLB组(简称TQ组)为超声引导下胸椎旁神经阻滞联合腰方肌阻滞组。记录患者麻醉前(T0)、麻醉后10 min(T1)、置入输尿管导管时(T2)、建立经皮肾镜碎石通道时(T3)、手术结束(T4)及出室时(T5)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)以及视觉模拟疼痛评分。记录2组患者的阻滞平面范围,记录额外使用阿片类药物情况,记录麻醉后不良事件的发生情况(包括恶心、呕吐、瘙痒、呼吸抑制、局麻药中毒、异常广泛阻滞)。结果 2组患者术中不同时间点的MAP、HR、SpO2组间比较差异无统计学意义(P>0.05);2组患者在T2时间点的VAS评分分别为(2.20±1.80)分与(0.48±1.00)分,差异有统计学意义(P<0.05),T组与TQ组在T3时间点的VAS分别为(0.12±0.43)分与(0.36±0.90)分,VAS评分比较差异无统计学意义(P>0.05),其余各时间点VAS评分比较差异无统计学意义(P>0.05);2组患者在T2时间点使用阿片类药物患者的例数分别为17例和4例,差异有统计学意义(P<0.05)。2组患者术后并发症比较差异无统计学意义(P>0.05)。结论 超声引导下胸椎旁神经阻滞联合腰方肌阻滞在经皮肾镜碎石术中具有更好的镇痛效果,患者在围术期血流动力学稳定,不增加术后并发症。Objective To explore the anesthesia effect of ultrasound-guided thoracic paravertebral nerve block combined with quadratus lumbosum block in percutaneous nephrolithotripsy.Methods Sixty patients undergoing elective percutaneous nephrolithotomy were selected as the study subjects and randomly divided into two groups,with 30 patients in each group.TPVB group(T group):ultrasound-guided thoracic paravertebral nerve block group;TPVB+QLB group(TQ group):ultrasound-guided thoracic paravertebral nerve block combined with quadratus lumborus muscle block group.Mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO 2)and point visual analogue pain score were recorded before anesthesia(T 0),10 min after anesthesia(T 1),at the time of insertion ureteral catheters(T 2),at the time of establishing percutaneous nephrolithotripsy(T 3),at the end of surgery(T 4),and at the time of exit(T 5).The range of anesthesia plane,the additional use of opioids and the occurrence of adverse events after anesthesia(including nausea,vomiting,pruritus,respiratory depression,local anesthetic poisoning,abnormal extensive anesthesia)in both group.Results There was no significant difference in MAP,HR and SpO 2 between the two groups at different time points(P>0.05).The VAS scores of the 2 groups at T 2 time point were(2.20±1.80)and(0.48±1.00),the difference was statistically significant(P<0.05),and the VAS scores of the T group and the TQ group at T 3 time point were(0.12±0.43)and(0.36±0.90),respectively.There was no significant difference in VAS score(P>0.05),and no significant difference in VAS score at other time points(P>0.05).The number of patients using opioids at T 2 time point in the 2 groups was 17 and 4,respectively,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative complications between 2 groups(P>0.05).Conclusion Ultrasound-guided thoracic paravertebral nerve block combined with quadratus lumborus muscle block has better analgesic in percutaneous nephrolithotripsy,a

关 键 词：经皮肾镜碎石术 胸椎旁神经阻滞 腰方肌阻滞 

分 类 号：R614[医药卫生—麻醉学]