超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞在腹膜透析置管术中的应用

Application of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Rectus Sheath Block in Peritoneal Dialysis Catheterization

目的探讨超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞用于腹膜透析置管术的有效性和安全性。方法对32例拟行择期腹膜透析置管术的病人在超声引导下采用腹横肌平面阻滞联合腹直肌鞘阻滞麻醉。观察32例病人阻滞前(T0)、切皮时(T1)、分离腹直肌时(T2)、进入腹腔时(T3)、置管时(T4)、做皮下遂道时(T5)、缝合荷包时(T6)、缝皮时(T7)、出手术室时(T8)和术后24h(T9)、术后48h(T10)的收缩压(SBP)、舒张压(DBP)及心率(HR)值的变化,感觉神经阻滞起效时间、镇痛起效时间、阻滞麻醉消退时间及T1-10时的疼痛程度评分[采用数字评分法(VAS)评分]和围术期不良反应(恶心、呕吐、低血压、皮肤瘙痒、尿潴留、局麻药毒性反应等)、并发症(穿刺部位血肿、感染、内脏损伤、神经系统并发症等)发生率。结果 32例病人中,T1-8时VAS评分均明显低于T9-10(均P<0.05)。与T0比较,T1-10时SBP、DBP和T9-10时HR值均无明显变化(P>0.05),T1-8时HR值均明显降低(均P<0.05)。32例病人围术期无一例出现不良反应及并发症。结论超声引导下腹横肌平面阻滞联合腹直肌鞘阻滞用于腹膜透析置管术是安全、有效的。

Objective To explore the efficacy and safety of ultrasound-guided transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization.Methods Thirty-two patients scheduled for elective peritoneal dialysis catheterization underwent ultrasound-guided transversus abdominis plane block and rectus sheath block.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）and heart rate（HR）were measured at different timepoints：pre-block（T0）,skin incision（T1）,rectus abdominis muscle separation（T2）,entering abdominal cavity（T3）,catheterization（T4）,forming subcutaneous tunnel（T5）,pouch suturing（T6）,skin closure（T7）,discharge from operating room（T8）,24 hours after operation（T9）,and48 hours after operation（T10）.The degree of pain was assessed at T1-10 using visual analogue scale（VAS）.In addition,the onset time of sensory nerve block and analgesia,regression time of block anesthesia,perioperative adverse reactions（nausea,vomiting,hypotension,itchy skin,urinary retention,local anesthetic toxicity,etc.）,and complications（puncture site hematoma,infection,visceral injury,neurological complications,etc.）were observed.Results The VAS scores at T1-8 were significantly lower than those at T9-10（P〈0.05）.Compared with T0,there were no significant changes in SBP and DBP at T1-10,as well as in HR at T9-10（P〈0.05）.The HR at T1-8 was significantly lower than that at T0（P〈0.05）.No adverse reactions and complications occurred during the perioperative period in all patients.Conclusion Ultrasound-guided transversus abdominis plane block combined with rectus sheath block is safe and effective for peritoneal dialysis catheterization.