术前肋间神经阻滞对择期行后腹腔镜肾肿物切除术患者围术期应激反应及镇痛效果的影响  

Effect of preoperative intercostal nerve block on perioperative stress response and analgesic effect in patients undergoing elective retroperitoneal laparoscopic nephrectomy

作　　者：刘洁 李玉婷 孙兴伟 LIU Jie;LI Yu-ting;SUN Xing-wei(Department of Anesthesiology,Xi'an Hospital of Traditional Chinese Medicine,Xi'an Shaanxi 710021,China)

机构地区：[1]西安市中医医院麻醉科,陕西西安710021

出　　处：《临床和实验医学杂志》2025年第2期219-223,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省重点研发计划项目(编号:2022SF-369)。

摘　　要：目的研究择期行后腹腔镜肾肿物切除术患者治疗中术前肋间神经阻滞对其围术期应激反应及镇痛效果的影响。方法前瞻性选取2023年1月至2024年1月入西安市中医医院的150例后腹腔镜肾肿物切除术患者,按照随机数字表法将其分为观察组(n=75)与对照组(n=75)。观察组手术之前输注2 mg吗啡+10 mg地塞米松+0.375%罗哌卡因阻滞腋后线第8-12胸椎神经,对照组输注20 mL 0.9%氯化钠溶液。两组均行全身麻醉,接受后腹腔镜肾肿物切除术治疗。比较两组患者不同时间段(术前、气腹建立10 min时、术后1 d)白细胞介素(IL)-6、IL-10水平变化,并比较两组患者不同时间段(术前、气腹建立10 min时、关腹时、术后1 d)皮质醇、去甲肾上腺素(NE)浓度、肾上腺素(E)变化、镇痛药物使用状况(舒芬太尼使用剂量、术后镇痛泵首次按压时间、术后72 h内镇痛泵按压次数)及肺不张发生率。结果术前、气腹建立10 min时、术后1 d,两组患者IL-6、IL-10水平比较,差异均无统计学意义(P>0.05);术后1 d,两组患者IL-6、IL-10水平均高于术前、气腹建立10 min时,差异均有统计学意义(P<0.05)。术前、术后1 d,两组患者的皮质醇、NE、E水平比较,差异均无统计学意义(P>0.05);两组患者气腹建立10 min时、关腹时的皮质醇、NE、E水平均高于术前,两组患者术后1 d皮质醇水平均低于术前,差异均有统计学意义(P<0.05);观察组患者气腹建立10 min时的皮质醇、NE、E水平分别为(121.86±55.63)μg/L、(52.64±24.85)pg/mL、(55.83±19.85)pg/mL,关腹时的皮质醇、NE、E水平分别为(146.29±62.37)μg/L、(62.08±28.36)pg/mL、(68.32±22.51)pg/mL,均低于对照组[气腹建立10 min时:(143.28±56.39)μg/L、(68.52±25.06)pg/mL、(94.31±28.41)pg/mL;关腹时:(175.03±65.39)μg/L、(78.86±28.51)pg/mL、(109.02±30.36)pg/mL],差异均有统计学意义(P<0.05)。观察组患者舒芬太尼使用剂量、术后72 h内镇痛泵按压次数分别�Objective To investigate the effects of intercostal nerve block on perioperative stress response and analgesia in patients undergoing elective retrolaparoscopic nephrectomy.Methods A total of 150 patients with retroperitoneal laparoscopic nephrectomy admitted to Xi'an Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were prospectively selected and divided into the observation group(n=75)and the control group(n=75)acording to the random number table method.Before operation,the observation group was given 2 mg morphine+10 mg dexamethasone+0.375%ropivacaine to block the 8-12 thoracic nerves of the posterior axillary line.The control group was given 20 mL 0.9%sodium chloride solution.Both groups underwent general anesthesia and retroperitoneal laparoscopic nephrectomy.The levels of interleukin(IL)-6 and IL-10 were compared between the two groups at different time periods(before operation,10 min after pneumoperitoneum establishment,1 day after operation),the concentrations of cortisol,norepinephrine(NE),epinephrine(E)at different time periods(before operation,10 min after pneumoperitoneum establishment,abdominal closure,1 day after operation),analgesic drug use(sufentanil dosage,the first pressing time of postoperative analgesia pump,the number of pressing times of analgesia pump within 72 h after operation)and incidence of atelectasis were compared between the two groups.Results There were no statistically significant differences in the levels of IL-6 and IL-10 between the two groups before operation,10 min after pneumoperitoneum establishment and 1 d after operation(P>0.05).At 1 day after operation,the levels of IL-6 and IL-10 in the two groups were higher than those before operation and 10 min after pneumoperitoneum establishment,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the levels of cortisol,NE and E between the two groups before and 1 day after operation(P>0.05).The levels of cortisol,NE and E at 10 min after pneumo

关 键 词：后腹腔镜肾肿物切除术 肋间神经阻滞 应激反应 镇痛效果 肺不张 

分 类 号：R61[医药卫生—外科学]