超声引导下竖脊肌平面阻滞对腹腔镜下直肠癌根治术后镇痛的效果

Clinical significance of ultrasound-guided erector spinae plane block in postoperative analgesia after laparoscopic radical resection of rectal cancer

摘要:

目的 探讨超声引导下竖脊肌平面阻滞对腹腔镜下直肠癌根治术后镇痛的影响。方法 选取2018年 1月—2018年12月佛山市第一人民医院行腹腔镜下直肠癌根治术患者60例。采用随机数字表法分为对照组和竖脊肌平面阻滞组（阻滞组），每组30例。阻滞组麻醉诱导前在双侧T8横突行单次竖脊肌平面阻滞，对照组不行阻滞，然后在静吸复合麻醉下行直肠癌根治术。术毕两组均采用静脉自控镇痛（PCIA）。记录气管导管拔管后即刻（T0）、术后3?h（T1）、6?h（T2）、12?h（T3）、24?h（T4）、36?h（T5）和48?h（T6）时静态VAS评分，记录T4～T6时动态VAS评分（患者在病床上翻身和坐起时）。统计术后0～24?h和>24～48?h舒芬太尼用量。记录患者镇痛泵首次按压时间、需要补救性镇痛的比例、肛门排气时间、首次下床活动时间和停留尿管时间，记录患者术后恶心呕吐、瘙痒、呼吸抑制和低氧血症发生率。术后48?h评估两组患者总体满意度。结果 与对照组患者比较，阻滞组患者在T0～T6时静态VAS评分和T4～T6时动态VAS评分均降低（P?<0.05）；与对照组患者比较，阻滞组患者首次按压镇痛泵的时间延长，术后24和48 h内舒芬太尼用量减少（P?<0.05），需要补救性镇痛的例数减少（P?<0.05）；与对照组患者比较，阻滞组患者术后恶心呕吐发生率降低（P?<0.05），而两组瘙痒、呼吸抑制和低氧血症发生率比较，差异无统计学意义（P?>0.05）；与对照组患者比较，阻滞组患者术后肛门排气时间、首次下床活动时间和停留尿管时间均缩短（P?<0.05）；阻滞组患者术后48?h总体满意度评分为（3.8±1.1）分，高于对照组患者的（1.8±0.7）分（P?<0.05）。结论 超声引导下竖脊肌平面阻滞能够为腹腔镜下直肠癌根治术患者提供良好的术后镇痛。

Abstract:

Objective To observe the effects of ultrasound-guided single erector spinae plane block (ESPB) on postoperative pain in patients undergoing laparoscopic radical resection of rectal cancer. Methods Sixty patients scheduled for laparoscopic radical resection of rectal cancer were randomly assigned into two groups, ESPB group and control group. ESPB was performed in group E before anesthesia induction. Visual analogue scale (VAS) scores were recorded at immediately after the extubation (T0), 3?h (T1), 6?h (T2), 12?h (T3), 24?h (T4), 36?h (T5) and 48?h (T6) after operation. At T4 to T6, the active exercise VAS scores were recorded. The first time of pressing the analgesic pump, the volume of analgesic drugs, the side effects and patients’ overall satisfaction were recorded. Recovery time of gastrointestinal function, ambulation time, the time of catheter retention were recorded as well. Results The VAS scores both at rest and exercise in group ESPB were lower than those in control group (P?