肋间神经阻滞对全麻后腹腔镜肾切除术围手术期应激指标及不良反应的影响  

The effect of intercostal nerve block on perioperative stress indicators and adverse reactions in patients undergoing laparoscopic nephrectomy under general anesthesia

作　　者：李阿兴 白静 高巍[2] 宗泽文 杨普 Li Axing;Bai Jing;Gao Wei;Zong Zewen;Yang Pu(Department of Urology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710089,China;Department of Anesthesiology,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710089,China)

机构地区：[1]西安交通大学第一附属医院泌尿外科,西安710089 [2]西安交通大学第一附属医院麻醉科,西安710089

出　　处：《国际泌尿系统杂志》2024年第4期609-614,共6页International Journal of Urology and Nephrology

基　　金：国家自然科学基金(面上项目)(81971290)。

摘　　要：目的评价肋间神经阻滞对全身麻醉下后腹腔镜肾切除术患者围手术期的应激指标及不良反应的影响。方法收集2021年1月至2023年12月本院收治的98例后腹腔镜肾切除术患者的临床资料,将患者随机分为观察组和对照组,每组各49例,术前分别采用肋间神经阻滞与常规生理盐水。比较两组患者的镇痛药物使用情况、血清C反应蛋白(CPR)、白细胞介素-6(IL-6)、皮质醇(COR)指标,评估术后疼痛程度[疼痛视觉模拟(VAS)评分],随访麻醉相关不良反应及术后并发症情况。结果观察组患者的舒芬太尼与吗啡用量较对照组更少,镇痛泵首次按压时间较对照组更晚,且按压次数少于对照组(均P<0.05);气腹后20 min、关腹时及术后24 h,两组患者的CPR、IL-6、COR均较术前升高(均P<0.05),但观察组的CPR、IL-6、COR均低于对照组(均P<0.05)。两组术后1 h的VAS评分比较,差异无统计学意义(P>0.05),术后24、48 h,观察组的VAS评分低于对照组(均P<0.05);观察组的麻醉相关不良反应发生率[6.12%(3/49)]低于对照组[20.41%(10/49)],差异有统计学意义(P<0.05);观察组的并发症发生率[2.04%(1/49)]低于对照组[16.33%(8/49)],差异有统计学意义(P<0.05)。结论全身麻醉下的后腹腔镜肾切除术患者术前采用肋间神经阻滞,能够减轻围手术期的应激反应及减少麻醉药物用量,降低麻醉相关不良反应发生率及并发症发生率。Objective To evaluate the effect of intercostal nerve block on perioperative stress indicators and adverse reactions in patients undergoing laparoscopic nephrectomy under general anesthesia.Methods A prospective study was conducted on patients(98 cases)who underwent laparoscopic nephrectomy in our hospital from January 2021 to December 2023.The patients were randomly divided into observation group and control group,49 cases in each group.Intercostal nerve block and conventional saline were used for patients before surgery,respectively.Use of analgesic drugs,C-reactive protein(CRP),interleukin-6(IL-6),and cortisol(COR)indicators between two groups,evaluate postoperative pain severity[visual analogue scale(VAS)scores],and follow up on anesthesia related adverse reactions and postoperative complications were compared.Results The dosage of sufentanil and morphine in observation group was less than that in control group,the time of first analgesic pump was applied later than that in control group,and The Times of analgesic pump was less than that in control group(all P<0.05).At 20 min after pneumoperitoneum,at abdominal closure and 24 hours after surgery,the CPR,IL-6 and COR of both groups were higher than those before surgery(all P<0.05),but the CPR,IL-6 and COR of observation group were lower than those of control group(all P<0.05).There was no significant difference in the VAS score 1 hour after surgery between the two groups(P>0.05).Twenty-four and forty-eight hours after surgery,the VAS scores of the observation group was lower than that of the control group(all P<0.05).The incidence of anesthesia related adverse reactions in the observation group[6.12%(3/49)]was lower than that in the control group[20.41%(10/49)],and the difference was statistically significant(P<0.05).The incidence of complications in the observation group[2.04%(1/49)]was lower than that in the control group[16.33%(8/49)],and the difference was statistically significant(P<0.05).Conclusions Preoperative intercostal nerve block under general anes

关 键 词：腹腔镜检查 肾切除术 肋间神经 麻醉 全身 围手术期 

分 类 号：R699.2[医药卫生—泌尿科学]