腹直肌鞘阻滞联合静脉自控镇痛对胃癌根治手术患者的镇痛效果及术后恢复的影响

Effect of rectus sheath block combined with patient-controlled intravenous analgesia on perioperative analgesia and recovery after radical gastrectomy

目的观察超声引导下腹直肌鞘阻滞复合静脉自控镇痛(PCIA)对胃癌根治术患者的镇痛效果及术后恢复的影响。方法选取行胃癌根治手术患者80例,按随机数字表法分为腹直肌鞘阻滞联合PCIA组(R组)和单纯PCIA组(P组),每组40例,R组麻醉诱导后行超声引导下双侧腹直肌鞘阻滞;P组不予处理;两组患者术后均行舒芬太尼PCIA。观察并记录术中七氟醚用量及舒芬太尼用量,于患者术后2h(T_1)、6h(T_2)、12h(T_3)、24h(T_4)、48h(T_5)5个时点评估并记录患者视觉模拟评分(VAS),PCIA舒芬太尼用量,不良反应发生情况;记录术后48h内镇痛不全例数及追加镇痛药物情况;随访记录患者首次下床活动时间、首次排气时间及住院时间。结果 R组术中及术后2、6h舒芬太尼用量明显少于P组(P<0.05),R组的下床时间和排气时间上均较P组提前,镇痛不全情况较少(P<0.05);两组在术中七氟烷用量、术后静息VAS、术后12、24、48h舒芬太尼用量、住院天数、术后追加止痛药物及相关不良反应发生率比较差异均无统计学意义。结论腹直肌鞘阻滞联合PCIA能为胃癌根治术患者术中及术后提供有效镇痛,减少镇痛不全情况的发生,有利于胃癌患者术后的康复。

Objective To assess the effect of ultrasound-guided rectus sheath block （RSB） combined withpatient-controlled intravenous analgesia （PCIA） on perioperative analgesia and recovery in patients after radical gastrectomy.Methods Eighty patients with gastric cancer scheduled for radical gastrectomy were randomly assigned in two groups with 40cases in each group. All patients received PCIA after surgery, patients in group R received additional ultrasound-guided RSBafter general anesthesia and patients in group P received PCIA alone. The intraoperative dosage of sevoflurane and sufentanil,the dosage of sufentanil and visual analogue scale （VAS） score of pain at 2, 6, 12, 48 and 48h after surgery, adverse reactions,insufficient analgesia and additional analgesic cases, the time to gastrointestinal function recovery, ambulation and length ofhospital stay were compared in two groups. Results Compared with group P, the intraoperative dosage of sufentanil and 2h, 6hafter surgery in group R was significantly lower than those in group P, the times to gastrointestinal function recovery and firstambulation in group R were shorter, and insufficient analgesia cases were less than those in group P （all P〈0.05）. There were nosignificant differences in VAS scores, supplemental analgesia, intraoperative dosage of sevoflurane, dosage of sufentanil at 12h,24h and 48h after surgery, the analgesia-related side effects and the duration of hospital stay （P〉0.05）. Conclusion Rectussheath block combined with PCIA provides better intraoperative and postoperative analgesia and less insufficient analgesia forpatients with radical gastrectomy.