超声引导腹外斜肌肋间肌平面阻滞在腔镜胰十二指肠切除术中的镇痛效果  

Analgesic effect of ultrasound-guided intercostal muscle plane block of external oblique muscle in endoscopic pancreaticoduodenectomy

作　　者：赵秀秀 张勇[1] 赵倩[1] 蒋宇智[1] 史宏伟[1] 鲍红光[1] 王宏宇[1] Zhao Xiuxiu;Zhang Yong;Zhao Qian;Jiang Yuzhi;Shi Hongwei;Bao Hongguang;Wang Hongyu(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院、南京市第一医院麻醉疼痛与围术期医学科,南京210006

出　　处：《中国医师杂志》2025年第1期28-32,共5页Journal of Chinese Physician

基　　金：国家自然科学基金(81873954);南京市卫生科技发展专项基金(YKK19081)。

摘　　要：目的评价腹外斜肌肋间肌平面阻滞用于腔镜胰十二指肠切除术患者的镇痛效果。方法前瞻性选择2023年2月—7月南京市第一医院择期全麻下行腔镜胰十二指肠切除术患者48例,将患者按随机数字表法分为两组(n=24):腹外斜肌肋间肌平面阻滞联合全麻组(EG组)和单纯全麻组(G组)。EG组在全麻诱导前行腹外斜肌肋间肌平面阻滞,两侧分别注入0.375%罗哌卡因20 ml。两组术毕均行患者自控静脉镇痛(PCIA),维持疼痛视觉模拟量表(VAS)评分<4分。VAS评分≥4分时,静脉注射羟考酮1 mg补救镇痛。记录拔管后30 min(T_(0))、6 h(T_(1))、12 h(T_(2))、24 h(T_(3))、48 h(T_(4))的VAS评分,术中药物及液体用量,术后睡眠质量,镇痛满意度评分,补救镇痛及不良反应发生情况。结果EG组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)时静息和运动VAS评分均显著低于G组(均P<0.05)。EG组患者去氧肾上腺素、丙泊酚、瑞芬太尼用量及液体总输注量均显著少于G组(均P<0.05)。EG组睡眠质量、镇痛满意度优于G组(均P<0.05),术后PCIA首次按压时间长于G组(P<0.05),有效按压次数、羟考酮补救镇痛用量、恶心呕吐发生占比、麻醉科重症监护室(AICU)停留时间均少于G组(均P<0.05),两组总住院时间差异无统计学意义(P>0.05)。结论与单纯全麻相比,腹外斜肌肋间肌平面阻滞联合全麻用于腔镜胰十二指肠切除术患者,术后镇痛效果显著,不仅降低术后VAS评分、减少阿片类药物用量,且能提高睡眠质量,增加术后镇痛满意度。超声引导腹外斜肌肋间肌平面阻滞可以作为一种较好的镇痛方法应用于腔镜胰十二指肠切除术。Objective To evaluate the analgesic effect of intercostal muscle plane block of external oblique muscle in patients undergoing endoscopic pancreaticoduodenectomy.MethodsA total of 48 patients undergoing endoscopic pancreaticoduodenectomy under elective general anesthesia in Nanjing First Hospital from February to July 2023 were prospectively selected and divided into two groups(n=24)according to random number table method:abdominal external oblique intercostal muscle plane block combined with general anesthesia group(EG group)and general anesthesia group(G group).The EG group was blocked in the intercostal muscle plane of the external oblique muscle before general anesthesia induction,and 0.375%ropivacaine 20 ml was injected on both sides,respectively.Patient-controlled intravenous analgesia(PCIA)was performed in both groups after operation,and the pain Visual Analogue Scale(VAS)score was less than 4 points.When the VAS score was≥4,1 mg oxycodone was injected intravenously for relief and analgesia.VAS scores at 30 min(T_(0)),6 h(T_(1)),12 h(T_(2)),24 h(T_(3)),48 h(T_(4))after extubation,intraoperative drug and fluid dosage,postoperative sleep quality,analgesic satisfaction score,remedial analgesia and the occurrence of adverse reactions were recorded.ResultsThe scores of rest and exercise VAS at T_(0),T_(1),T_(2),T_(3) and T_(4) in the EG group were significantly lower than those in the G group(all P<0.05).The dosage of norepinephrine,propofol,remifentanil and total fluid infusion in the EG group were significantly lower than those in the G group(all P<0.05).The sleep quality and analgesic satisfaction of the EG group were better than those of the G group(all P<0.05),the first time of PCIA compression after surgery was longer than that of the G group(P<0.05),the number of effective compressions,the amount of oxycodone relief and analgesia,the proportion of nausea and vomiting,and the stay time of anesthesia intensive care unit(AICU)were lower than those of the G group(all P<0.05).There was no significant differ

关 键 词：胰十二指肠切除术 腹腔镜检查 神经传导阻滞 腹外斜肌肋间肌平面阻滞 镇痛 

分 类 号：R61[医药卫生—外科学]