超声引导下高位胸段竖脊肌平面阻滞对腹腔镜术后肩痛发生率的影响  

Effect of ultrasound-guided high thoracic-erector spinal plane block on the incidence of post-laparoscopic shoulder pain

作　　者：梁颖思 刘尧 陈倩 王心雨 方明 陈肖 LIANG Yingsi;LIU Yao;CHEN Qian;WANG Xinyu;FANG Ming;CHEN Xiao(Jiangsu Province Key Laboratory of Anesthesiology,Xuzhou Medical University,Jiangsu Province,Xuzhou221004,China;Department of Pain Management,Affiliated Hospital of Jiangnan University,Jiangsu Province,Wuxi214000,China;Wuxi Medical College,Jiangnan University,Jiangsu Province,Wuxi214000,China;Department of Anesthesiology,Affiliated Hospital of Jiangnan University,Jiangsu Province,Wuxi214000,China)

机构地区：[1]徐州医科大学江苏省麻醉学重点实验室,江苏徐州221004 [2]江南大学附属医院疼痛科,江苏无锡214000 [3]江南大学无锡医学院,江苏无锡214000 [4]江南大学附属医院麻醉科,江苏无锡214000

出　　处：《中国医药导报》2024年第30期115-119,128,共6页China Medical Herald

摘　　要：目的探讨超声引导下高位胸段竖脊肌平面阻滞(HT-ESPB)对腹腔镜术后肩痛(PLSP)发生率的影响。方法选择2023年2月至10月江南大学附属医院择期行全麻腹腔镜手术的患者120例,采用随机数字表法将其分为对照组(T_(8)水平ESPB)和试验组(T_(2)联合T_(8)水平ESPB),每组60例。比较两组术后6、12、24、48 h PLSP的发生率,肩痛及静息和咳嗽状态下腹痛的数字评分法(NRS)评分;比较术后48 h内镇痛泵按压次数、舒芬太尼用量和补救镇痛情况;比较两组术前、术后当晚、术后第2天理查兹-坎贝尔睡眠问卷(RCSQ)评分;记录两组神经阻滞并发症和阿片类药物相关不良反应发生情况。结果与对照组比较,试验组术后12、24、48 h的PLSP发生率降低(P<0.05)。与对照组比较,试验组术后12、24 h肩痛的NRS评分降低(P<0.05)。两组术后各时间点静息和咳嗽状态下腹痛NRS评分比较,差异无统计学意义(P>0.05)。与对照组比较,试验组术后镇痛泵按压次数、舒芬太尼用量降低(P<0.05);两组术后补救镇痛例数及地佐辛用量比较,差异无统计学意义(P>0.05)。与本组术前比较,对照组术后当晚及术后第2天RCSQ评分降低(P<0.05);试验组术后当晚RCSQ评分降低(P<0.05)。与对照组比较,试验组术后当晚RCSQ评分升高(P<0.05)。两组均未见神经阻滞并发症发生。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论超声引导下HT-ESPB可以降低PLSP的发生率和疼痛评分,减少阿片类药物用量,安全性高,值得临床推广应用。Objective To explore the effect of ultrasound-guided high thoracic-erector spinal plane block(HT-ESPB)on the incidence of post-laparoscopic shoulder pain(PLSP).Methods A total of 120 patients scheduled for elective laparoscopic surgery under general anesthesia in the Affiliated Hospital of Jiangnan University from February to October 2023 were selected.According to the random number table method,They were divided into control group(T_(8)level ESPB)and experimental group(T_(2)combined with T_(8)level ESPB),with 60 patients in each group.The incidence of PLSP,the score of numerical rating scale(NRS)of shoulder pain and abdominal pain at resting and coughing state at 6,12,24,48 hours after surgery between two groups were compared;the number of analgesic pump compression,Sufentanil dosage,and relief analgesia were compared within 48 hours after surgery between two groups were compared;the score of Richards-Campbell sleep questionnaire(RCSQ)were compared between two groups before surgery,on the night after surgery,and on the second day after surgery;and nerve blockade associated complications and opioid-related adverse reactions were recorded between two groups.Results Compared with control group,the incidence of PLSP was decreased at 12,24 hours,and 48 hours after surgery(P<0.05).Compared with control group,the NRS score of shoulder pain at 12 hours and 24 hours after surgery in experimental was decreased(P<0.05).There was no significant difference in NRS scores of abdominal pain at rest and cough state between two groups at each time point after surgery(P<0.05).Compared with control group,the times of postoperative analgesia pump and the dosage of Sufentanil in experimental group were decreased(P<0.05);there was no significant difference in the number of postoperative analgesia and the dosage of Dezocine between two groups(P>0.05).Compared with the group before surgery,RCSQ scores of control group were decreased on the night after surgery and the second day after surgery(P<0.05);the RCSQ score of experimental group

关 键 词：竖脊肌平面阻滞 腹腔镜术后肩痛 膈神经阻滞 超声引导 

分 类 号：R971[医药卫生—药品]