右侧星状神经节阻滞对腹腔镜胆囊切除术后肩痛的影响  

Effect of right stellate ganglion block on shoulder pain after laparoscopic cholecystectomy

作　　者：李晗 呼远 白智远[3] 李芝燕 莫一凡 李若瑾 张二飞[1] LI Han;HU Yuan;BAI Zhiyuan;LI Zhiyan;MO Yifan;LI Ruojin;ZHANG Erfei(Department of Anesthesiology,Affiliated Hospital of Yan'an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院麻醉科,716000 [2]延安大学附属医院肝胆胰外科,716000 [3]延安大学附属医院东关分院重症医学科

出　　处：《临床麻醉学杂志》2024年第2期150-154,共5页Journal of Clinical Anesthesiology

基　　金：延安市基于ERAS下的临床麻醉管理科技创新团队项目(2021-21)。

摘　　要：目的探讨右侧星状神经节阻滞(SGB)对腹腔镜胆囊切除术(LC)患者术后肩痛的影响。方法选择2022年4—8月行LC患者104例,男32例,女72例,年龄18~64岁,ASAⅠ或Ⅱ级。将患者随机分为两组:SGB组(S组,n=51)和对照组(C组,n=53)。气管插管后即刻,S组使用0.2%罗哌卡因4 ml进行超声引导下的右侧SGB;C组在相同部位注射生理盐水4 ml。记录术后48 h内腹腔镜术后肩痛(PLSP)例数和PLSP持续时间;记录术毕即刻(T_(1))、术后2 h(T_(2))、6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))PLSP的VAS疼痛评分,评估PLSP程度;记录PCIA泵有效按压次数、补救镇痛例数;记录恶心、呕吐、腹胀等不良反应的发生情况。结果S组PLSP发生率、PLSP持续时间>10 h比例明显低于C组(P<0.05)。T_(3)—T_(5)时S组PLSP程度明显轻于C组(P<0.05)。S组PCIA泵有效按压次数明显少于C组,补救镇痛率明显低于C组(P<0.05)。S组恶心发生率明显低于C组(P<0.05)。结论右侧星状神经节阻滞可以降低LC患者PLSP发生率,缓解PLSP疼痛程度,降低不良反应发生率。Objective To investigate the effect of right stellate ganglion block(SGB)on postoperative shoulder pain in patients receiving laparoscopic cholecystectomy(LC).Methods A total of 104 patients scheduled for LC from April to August 2022,32 males and 72 females,aged 18-64 years,ASA physical statusⅠorⅡ,were selected and randomized into two groups:the stellate ganglion block group(group S,n=51)and the control group(group C,n=53).Immediately after intubation,0.2%ropivacaine 4 ml was used for ultrasound-guided right SGB in group S,and saline 4 ml was injected at the same site in group C.The number of cases of post-laparoscopic shoulder pain(PLSP)and the duration of PLSP were recorded within 48 hours after operation.The VAS pain scores of PLSP were recorded to assess the level of PLSP immediately after operation(T_(1)),2 hours after operation(T_(2)),6 hours after operation(T_(3)),12 hours after operation(T_(4)),24 hours after operation(T_(5)),and 48 hours after operation(T_(6)).The number of effective compressions of the PCIA pump and the salvage analgesia were recorded.The adverse reactions such as nausea,vomiting,and abdominal distension were recorded.Results The incidence of PLSP and the rate of patients with PLSP lasting more than 10 hours in group S was significantly lower than those in group C(P<0.05),and the degree of PLSP in group S was significantly lower than that in group C at T_(3)-T_(5)(P<0.05).The number of effective compressions of the PCIA pump and the salvage analgesia rate in group S was significantly lower than those in group C(P<0.05).The incidence of nausea in group S was significantly lower than that in group C(P<0.05).Conclusion Right stellate ganglion block can reduce the incidence of PLSP in patients receiving LC,relieve the pain degree of PLSP,and reduce the incidence of adverse reactions.

关 键 词：右侧星状神经节阻滞 腹腔镜胆囊切除术 术后肩痛 不良反应 

分 类 号：R614[医药卫生—麻醉学]