竖脊肌平面阻滞复合酮咯酸氨丁三醇预防性镇痛对腹腔镜胃癌根治术患者术后镇痛及早期恢复的影响  

Effects of prophylactic analgesia using erector spinae plane block combined with ketorolac tromethamine on postoperative analgesia and early recovery of patients undergoing laparoscopic radical gastrectomy

作　　者：李静[1] 郭伟[2] 武毅鹏 徐学敏[3] 姜涛[3] 田首元 Li Jing;Guo Wei;Wu Yipeng;Xu Xuemin;Jiang Tao;Tian Shouyuan(College of Anesthesia,Shanxi Medical University,Taiyuan 030001,China;Department of Gastrointestinal Surgery,Heji Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China;Department of Anesthesiology,Heji Hospital Affiliated to Changzhi Medical College,Changzhi 046000,China;Department of Anesthesiology,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]长治医学院附属和济医院胃肠外科,长治046000 [3]长治医学院附属和济医院麻醉科,长治046000 [4]山西省人民医院麻醉科,太原030012

出　　处：《肿瘤研究与临床》2025年第2期132-137,共6页Cancer Research and Clinic

基　　金：山西省高等学校科技创新项目(2022L392)。

摘　　要：目的探讨竖脊肌平面阻滞(ESPB)复合酮咯酸氨丁三醇预防性镇痛对腹腔镜胃癌根治术患者术后镇痛及早期恢复的影响。方法前瞻性随机对照研究。选取2022年6月至2023年10月长治医学院附属和济医院接受腹腔镜胃癌根治术治疗的105例胃癌患者,采用随机数字表法分为ESPB+酮咯酸氨丁三醇组(T组)、ESPB组(C1组)、酮咯酸氨丁三醇组(C2组),每组35例。预防性镇痛方法:T组术前采用ESPB+酮咯酸氨丁三醇,C1组术前仅采用ESPB,C2组术前仅采用酮咯酸氨丁三醇。比较3组患者术中舒芬太尼、瑞芬太尼用量及术后静息疼痛视觉模拟评分法(VAS)评分、补救镇痛情况、恢复情况及并发症发生情况。结果3组患者基线特征及术中情况比较,差异均无统计学意义(均P>0.05)。T组术中舒芬太尼用量少于C1组和C2组[30(25,30)μg比35(30,35)μg比40(35,45)μg],差异有统计学意义(Z=33.03,P<0.001);T组术中瑞芬太尼用量少于C1组和C2组[0.34(0.30,0.40)mg比0.40(0.30,0.50)mg比0.70(0.60,0.85)mg],差异有统计学意义(Z=53.84,P<0.001)。T组术后1、6、12、24、48 h的VAS评分均低于C1组和C2组,差异均有统计学意义(均P<0.001)。T组镇痛泵按压次数少于C1组和C2组[1(0,2)次比2(1,2)次比4(3,5)次],差异有统计学意义(Z=48.10,P<0.001)。T组术后首次排气时间、下床时间、住院天数均短于C1组和C2组,差异均有统计学意义(均P<0.001)。3组术后恶心、呕吐、头晕、皮肤瘙痒、肺炎、吻合口瘘发生率比较,差异均无统计学意义(均P>0.05)。3组术后均未出现嗜睡、低血压、呼吸抑制。结论使用ESPB复合酮咯酸氨丁三醇预防性镇痛可有效减轻腹腔镜胃癌根治术患者的术后疼痛,减少镇痛类药物的使用,促进患者术后早期恢复,且不增加术后并发症。ObjectiveTo investigate the effects of prophylactic analgesia using erector spinae plane block(ESPB)combined with ketorolac tromethamine on postoperative analgesia and early recovery of patients undergoing laparoscopic radical gastrectomy.MethodsA prospective randomized controlled study was conducted.A total of 105 gastric cancer patients who underwent laparoscopic radical gastrectomy in Heji Hospital Affiliated to Changzhi Medical College from June 2022 to October 2023 were selected,and the patients were divided into ESPB+ketorolac tromethamine group(T group),ESPB group(C1 group),and ketorolac tromethamine group(C2 group)by using the random number table method,with 35 cases in each group.The prophylactic analgesia method was preoperative ESPB+ketorolac tromethamine in T group,preoperative ESPB in C1 group and preoperative ketorolac tromethamine in C2 group.The intraoperative sufentanil and remifentanil dosage and the postoperative resting pain visual analogue scale(VAS)score,remedial analgesia,recovery status and complication occurrence were compared among the 3 groups.ResultsThe baseline characteristics and intraoperative conditions of the patients in the 3 groups were compared,and the differences were not statistically significant(all P>0.05).The intraoperative sufentanil dosage in T group was less than that in C1 and C2 groups[30(25,30)μg vs.35(30,35)μg vs.40(35,45)μg],and the difference was statistically significant(Z=33.03,P<0.001);the intraoperative remifentanil dosage in T group was less than that in C1 and C2 groups[0.34(0.30,0.40)mg vs.0.40(0.30,0.50)mg vs.0.70(0.60,0.85)mg],and the difference was statistically significant(Z=53.84,P<0.001).The VAS scores at 1,6,12,24,48 h after surgery in T group were lower than those in C1 and C2 groups,and the differences were statistically significant(all P<0.001).The press number of analgesic pump in T group was less than that in C1 and C2 groups[1(0,2)times vs.2(1,2)times vs.4(3,5)times],and the difference was statistically significant(Z=48.10,P<0.001).The posto

关 键 词：胃肿瘤 预防性镇痛 竖脊肌平面阻滞 酮咯酸氨丁三醇 

分 类 号：R73[医药卫生—肿瘤]