超声引导下竖脊肌平面阻滞在经腹胰十二指肠切除术中的应用观察

Ultrasound-guided Erector Spinae Plane Block in Transabdominal Pancreatoduodenectomy

目的观察经腹胰十二指肠切除术(PD)术前预先给予超声引导下竖脊肌平面阻滞(ESP)后对术中麻醉药物用量及术毕复苏情况的影响。方法选取我院2016年12月～2017年11月期间择期拟行经腹PD患者48例,计算机随机数表随机双盲分为对照组(C组)和竖脊肌平面阻滞组(ESP组),每组24例。对照组患者实施全凭静脉麻醉,ESP组患者先在超声引导下进行T8双侧ESP,再实施全凭静脉麻醉。记录两组患者术中的平均动脉压(MAP)及丙泊酚、舒芬太尼、雷米芬太尼、顺式阿曲库铵的使用量,并观察两组患者术毕复苏情况。结果 PD术中ESP组患者的MAP与C组相差无统计学意义,而拔管后30min时ESP组显著低于C组(P<0. 05);ESP组的丙泊酚用量与C组差别无统计学意义,但舒芬太尼、雷米芬太尼和顺式阿曲库铵的用量均显著低于C组(P<0. 05);ESP组患者术毕苏醒及拔管时间与C组相比明显缩短(P<0. 05),且拔管后30min的VAS评分显著低于C组(P<0. 05),出现烦躁和恶心呕吐的患者显著少于C组(P<0. 05)。结论经腹PD术前预先给予ESP可显著减少术中阿片类药物的使用,明显提高术毕复苏质量。

Objective To observe the effect of pre - operative ultrasound - guided erector spinae plane （ESP） block on anesthetic dosage and resuscitation in transabdominal pancreatoduodenectomy （PD） . Methods 48 cases for selective transabdominal PD during the period from Dec. , 2016 to Nov. , 2017 were enrolled and randomly divided into 2 groups ： ESP group and control group, 24 in each ; total intravenous anesthesia was performed on cases in control group while ultrasound - guided ESP block of the 8th thoracic vertebra first and then total intravenous anesthesia were made to cases in ESP group ; the mean arterial pressure （MAP） and the consumed dosage of propofol, sufentanil, remifentanil and cisatracurium in the 2 groups were recorded and the resuscitation of the cases in both groups were observed. Results There existed no statistical difference in MAP in operation between the 2 groups while at the time point of 30 minutes after extubation the MAP of the cases in ESP group was lower than that of the cases in control group （P 〈 0.05 ） ; the consumed dosage of propofol in ESP group was of no statistical difference from that in control group while the consumed dosages of sufentanil, remifentanil and cisatracurium in ESP group were obviously lower than those in control group （ P 〈 0.05 ） ; the time for resuscitation and extubation in ESP group was much shorter than that in control group （P 〈 0.05） and the VAS scores of the cases in ESP group at the time point of 30 minutes after extubation were lower than those in control group （ P 〈 0.05 ） , and irritability, nausea and vomiting occurred in less cases in ESP group than in control group （P 〈 0. 05 ）. Conclusions Pre - operative application of ultrasound - guided ESP block can obviously reduce the dosage of opioid drugs in transabdominal PD and significantly promote the quality of resuscitation.