超声引导下腹直肌鞘阻滞用于腹膜透析置管术

Use of ultrasound-guided abdominal rectus sheath block （RSB） for peritoneal dialysis catheter

目的 探讨超声引导下腹直肌鞘阻滞用于腹膜透析置管术的安全性和有效性.方法 选择2015年9月至2016年7月60例慢性肾功能不全患者拟行腹膜透析置管术患者为研究对象,随机分成腹直肌鞘阻滞组（R组）和局麻组（L组）,每组均为30例,R组患者切口中点行超声引导下腹直肌鞘阻滞,L组行局部浸润麻醉,统一手术,麻醉医生记录各时间点生命体征、补救局麻次数、成功置管所需次数以及手术持续时间.结果 两组患者一般资料无统计学差异;两组患者MAP、HR组内效应（时间）以及时间与分组的交互作用有统计学差异（P〈0.05）,MAP、HR变化趋势图可见手术期间尤其是牵拉腹直肌（T4）和手术结束时（T5）L组生命体征有较明显波动;组间比较：牵拉腹直肌时（T4）两组MAP、HR有统计学差异,与L组相比,R组术中补救局麻次数显著减少、置管所需次数较少且手术时间短（P＆lt;0.05）.结论 超声引导下腹直肌鞘阻滞用于腹膜透析置管术安全有效,可提高患者术中舒适度、手术过程更为顺畅,值得推广.

Objective To investigate the safety and efficacy of ultrasound-guided abdominal rectus sheath block （RSB） for peritoneal dialysis catheter. Methods Sixty patients with chronic renal insufficiency were included in the study between September 2015 and July 2016,and were randomly divided into the abdominal RSB group （group R） and topical anesthesia group （group L）,n=30 each. Group R underwent ultrasound-guided abdominal RSB at the midpoint line incision,and group L underwent local infiltration anesthesia with unified operation and anesthesiologists. The vital signs at each time point ,times of remedial local anesthesia,times of successful catheter and the duration of surgery were recorded. Results There was no statistically significant difference in the general data between the two groups（P〉0.05）. There were statistically significant differences in the effect（time）and interation of time and grouping between MAP and HR in the two groups（P〈0.05）. The MAP and HR changes in the trend figure showed that during the surgery,especially pulling the rectus abdominis（T4）and at the end of the surgery（T5）,the vital signs in group L significantly fluctuated. When pulling the rectus abdominis（T4）,there were significantly significant differences in MAP and HR between the two groups. Compared with group L,the times of remedial local anesthesia in group R was significantly reduced,and the times of required catheter was less and the operation time was shorter. Conclusion Using ultrasound-guided abdominal RSB is safe and effective for peritoneal dialysis catheter. It can improve the comfort of the patients during the operation,and the procedure is more smooth,which justifies widespread use.