摘要
目的探讨超声引导腹直肌鞘阻滞用于开腹直肠癌手术镇痛效果的观察。方法选择2019年1~12月全麻下行开腹直肠癌根治术患者100例,应用随机数字表法分为五组(n=20),Con、AM、BM、AO、BO组。Con组未行腹直肌鞘阻滞。AM、BM组行双侧腹直肌鞘多点阻滞(双侧脐平面、双侧耻骨联合及二者中点),分别给予0.25%、0.33%罗哌卡因,每点5mL。AO、BO组于脐平面行双侧腹直肌鞘阻滞,分别给予0.25%、0.33%罗哌卡因,每侧15mL。记录切皮前、后5min时的心率和平均动脉压;术中舒芬太尼的用量;术后2、6、12、24、48h静息状态视觉模拟评分和镇静评分;镇痛泵按压次数、补救镇痛次数及镇痛满意程度。结果五组切皮后5min心率和平均动脉压均升高,但Con组升高显著(P<0.05);舒芬太尼用量:AM、BM、AO、BO组明显少于Con组(P<0.05),AM、BM组明显少于AO、BO组(P<0.05),BO组少于AO组(P<0.05);VAS评分:与Con组比较,BM组各时间点评分均降低(P<0.05),AO、AM、BO组2~12h评分降低(P<0.05),AM、BM组2~12h评分低于AO、BO组(P<0.05),BO、BM组2~12h评分低于AO、AM组(P<0.05);镇痛泵按压次数:AO、AM、BO、BM组明显少于Con组(P<0.05),AM、BM组明显少于AO、BO组(P<0.05),BO、BM组少于AO、AM组(P<0.05);BM组镇痛满意度最高(P<0.05)。结论超声引导下应用0.33%罗哌卡因行腹直肌鞘多点阻滞,患者术中血流动力学更加平稳,术中阿片类药物用量减少,缓解患者术后疼痛。
Objective To probe into the observation of the analgesic effect of ultrasound-guided rectus sheath block applied to open colorectal surgery for rectal cancer.Methods 100 patients undergoing radical resection of rectal cancer under general anesthesia from January to December 2019 were selected and divided through random number method into five groups(n=20)such as the Con group,AM group,BM group,AO group and BO group.The con group was not receiving rectus sheath block.In AM group and BM group,bilateral rectus sheath multipoint block(bilateral umbilical plane,bilateral pubic symphysis and the midpoints of both)was performed,and 0.25%ropivacaine and 0.33%ropivacaine were administered respectively,with 5 mL for each point.The AO group and BO group received bilateral rectus sheath block at the umbilicus plane,and 0.25%ropivacaine and 0.33%ropivacaine were administered respectively,with 15 mL for each side.Those that were recorded included the heart rate(HR)and mean arterial pressure(MAP)5 min.before and 5 min.after skin incision,the dosage of sufentanil used during operations,visual simulation scores and sedation scores at resting state at 2,6,12,24 h and 48 h after operations,the times that the analgesic pump was pressed,the times of remedial analgesia,and the degree of satisfaction with analgesia.Results Both HR and MAP increased at 5 min after skin incision in the five groups,and they increased more significantly in the Con group(P<0.05).The dosage of sufentanil used:that of the AM group,BM group,AO group and BO group was significantly smaller than that of the Con group(P<0.05),that of the AM group and BM group was significantly smaller than that of the AO and BO group(P<0.05),and that of the BO group was smaller than that of the AO group(P<0.05).VAS scores:Compared with those of the Con group,the scores of the BM group decreased at all time points(P<0.05),the scores of the AO group,AM group and BO group decreased at 2-12 h(P<0.05),the scores of the AM group and BM group at 2-12 h were lower than those of the AO group and BO group(P<0.05),and the scores of the BO group and BM group at 2-12 h were lower than those of the AO group and AM group(P<0.05).The times that the analgesic pump was pressed:the times in the AO group,AM group,BO group and BM group were significantly less than those in the Con group(P<0.05),the times in the AM group and BM group were significantly less than those in the AO group and BO group(P<0.05),and the times in the BO group and BM group were less than those in the AO group and AM groups(P<0.05).The degree of satisfaction with analgesia in the BM group was the highest(P<0.05).Conclusion Ultrasound-guided application of 0.33%ropivacaine to rectus sheath multipoint block can promote hemodynamic stability of the patients during operations,reduce the dosage of opioid drugs used during operations and relieve the patients’postoperative pain.
作者
路文卿
李会
侯念果
帅训军
杨洪光
彭霄艳
石智勇
艾登斌
LU Wenqing;LI Hui;HOU Nian'guo;SHUAI Xunjun;YANG Hongguang;PENG Xiaoyan;SHI Zhiyong;AI Dengbin(School of Anesthesiology,Weifang Medical University,Shandong,Weifang 261000,China;Department of Anesthesiology,Qingdao Municipal Hospital,Shandong,Qingdao 266000,China)
出处
《中国医药科学》
2020年第16期5-10,共6页
China Medicine And Pharmacy
基金
山东省青岛市医疗卫生优秀人才培养项目(青卫科教字〔2019〕6号)。
关键词
超声引导
腹直肌鞘阻滞
多点阻滞
罗哌卡因
直肠癌
Ultrasound-guided
Rectus sheath block
Multipoint block
Ropivacaine
Rectal cancer
