对比三种麻醉方式用于腹膜透析置管术的效果

The Efficacy and Safety of Three Anesthetic Methods in the Peritoneal Dialysis Catheter Implantation

目的:对比气管导管全麻、喉罩全麻、超声引导下腹横肌平面阻滞(TAPB)用于腹膜透析置管术的效果。方法:选择行腹膜透析置管术的终末期肾病患者60例,对符合纳入标准者随机分为三组,各20例。气管导管组接受气管内插管全身麻醉;喉罩组接受喉罩全麻;TAPB组接受超声引导下TAPB麻醉。记录三组入室时(T0)、麻醉完成后即刻(T1)、手术开始时(T2)、手术结束后(T3)的平均动脉压(MBP)和心率(HR)变化;记录术中去甲肾上腺素及阿托品用量、手术时间、总麻醉时间(患者入室至清醒返回病房时间)、术后视觉模拟评分(Visual analogue scale,VAS)(术后2 h、6 h、12 h)、术后曲马多用量、术后咽喉不适、恶心呕吐发生例数、患者及手术医生麻醉满意度。结果:TAPB组在术中各观察点生命体征波动均小于气管导管组及喉罩组(P<0.05)。TAPB组血管活性药用量最少、总麻醉时间最短、术后不良反应最少(P<0.05)。TAPB组术后2 h及6 h VAS评分均低于另两组,术后曲马多用量减少约53%(P<0.05),而气管导管组和喉罩组间两个指标差异均无统计学意义(P>0.05)。TAPB组患者麻醉满意度总体高于气管导管组及喉罩组(P<0.05),气管导管组与喉罩组组间差异无统计学意义;三组手术医生满意度差异无统计学差异。结论:超声引导下TAPB可作为腹膜透析置管术安全、有效的麻醉方式之一;对于神经阻滞失败需改全麻病例,喉罩全麻相比于气管导管全麻更有优势。

Objective:To investigate the efficacy and safety of three anesthetic methods in the peritoneal dialysis(PD)catheter implantation.Methods:Sixty patients with end-stage renal disease who intended to receive PD catheter implantation were enrolled and randomly divided into three groups,20 cases in each group.The endotracheal group received general anesthesia with endotracheal intubation.The laryngeal mask group received general anesthesia with laryngeal mask intubation.The TAPB group received ultrasound guided transverse fascia plane nerve block anesthesia.The primary outcomes were the changes of heart rate and mean arterial pressure at different times,the vasoactive drugs application,and the times of operation or anesthesia.The VAS score after the surgery and the dosages of tramadol for analgesia after operation were recorded.Adverse events related to general anesthesia and the satisfaction to the anesthesia by the patients or operation doctors were also recorded.Results:The endotracheal group and laryngeal mask group had unstable hemodynamic and used more vasoactive drugs than TAPB group(P<0.05).Patients in TAPB group had better VAS scores after operation and used less tramadol than the other two groups(P<0.05).The TAPB group showed less adverse events and higher satisfaction of the patients.Conclusion:The ultrasound-guided TAPB can be an effective and safe anesthesia method for PD catheter implantation.