超声引导下腹横肌平面阻滞联合喉罩全身麻醉用于腹膜透析置管术的临床研究

Application of Ultrasound-Guided Transversus Abdominis Plane block Combined with Laryngeal Mask Anesthesia in Peritoneal Dialysis Catheter Placement

目的观察超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)联合喉罩全身麻醉用于腹膜透析置管术的术中应激反应和术后镇痛效果。方法将60例择期喉罩全身麻醉下拟行腹膜透析置管术的患者按随机数字表法分为TAPB组(T组)和对照组(C组),每组30例。2组麻醉诱导后行超声引导下手术侧TAPB,T组注入0.33%罗哌卡因25mL,C组注入等量生理盐水,术中静脉泵注丙泊酚维持麻醉,BIS值50~60。观察2组患者术中血压和心率变化;记录麻醉诱导前(T0)、手术结束时(T1)、手术结束6h(T2)血清皮质醇和血糖浓度,术后疼痛VAS评分,舒芬太尼用量,以及TAPB的相关并发症。结果与C组比较,T组术中SBP、DBP、HR明显降低(P<0.05);血清皮质醇和血糖浓度在T1、T2时间点显著下降(P<0.05);术后2、6、12h的VAS评分明显降低(P<0.05);术后24h镇痛泵按压次数、术中和术后舒芬太尼用量明显减少(P<0.05);2组患者术后均未出现穿刺后并发症(P>0.05)。结论超声引导下TAPB联合喉罩全麻用于腹膜透析置管术的术中应激反应低,全身麻醉药用量少,术后舒适度高,无穿刺后并发症。

Objective To observe the intraoperative stress response and postoperative analgesic effect of ultrasound-guided transversus abdominis plane block（TAPB）combined with laryngeal mask anesthesia in peritoneal dialysis catheterization.Methods Sixty patients scheduled for peritoneal dialysis catheter placement under general anesthesia were randomly divided into TAPB group（group T）and control group（group C）,with 30 patients in each group.TAPB was performed under the guidance of ultrasound.The group T was injected with 25 mL 0.33% ropivacaine.The group C was given the equal volume of normal saline.Intravenous infusion of propofol was used to maintain anesthesia during operation.The BIS value was 50-60.Changes in intraoperative blood pressure and heart rate were observed in both groups.Furthermore,the levels of serum cortisol and blood glucose were measured before anesthesia induction（T0）,at the end of surgery（T1）and 6 hours after operation（T2）.Moreover,postoperative VAS score,sufentanil dosage and TAPB-related complications were recorded.Results Compared with group C,systolic blood pressure,diastolic blood pressure,heart rate,serum cortisol and blood glucose levels at T1 and T2,VAS scores at 2,6 and 12 hours postoperatively,pressing times of analgesia pump at 24 hours postoperatively,and intraoperative and postoperative sufentanil dosages significantly decreased in group T（P〈0.05）.No postoperative complications were found in both groups（P〉0.05）.Conclusion Ultrasound-guided TAPB combined with laryngeal mask anesthesia for peritoneal dialysis catheterization has the advantages of little intraoperative stress response,low dose of general anesthetics,high postoperative comfort and few post-puncture complications.