超声引导竖脊肌平面阻滞在腹腔镜肾脏手术中的应用

The application of ultrasound-guided erector spinae plane block in patients undergoing laparoscopic kidney surgery

目的评估超声引导竖脊肌平面阻滞(erector spinae plane block,ESP)在腹腔镜肾脏手术中的应用。方法选择择期行腔镜肾脏手术的患者共60例,均分为竖脊肌阻滞联合全麻组(E组)和单纯全麻组(C组)。E组患者先以0.5%罗哌卡因30 mL行患侧竖脊肌神经阻滞。记录围术期患者的生命体征、麻醉药物用量、手术时间及苏醒时间,记录并比较术后1、6、12、24、48 h五个时点静息及咳嗽VAS评分,记录术后镇痛补救药物用量及静脉自控镇痛泵(PCIA)按压次数,观察术后不良反应的发生情况。结果E组患者麻醉药物用量及麻醉苏醒时间明显少于C组(P<0.05);E组患者术后6、12 h的静息VAS评分均降低(P<0.05),且术后1、6、12 h咳嗽状态VAS评分明显低于C组(P<0.05);E组患者镇痛泵按压次数及补救药物的用量均少于C组(P<0.05);两组患者术后均无明显不良反应。结论超声引导竖脊肌平面阻滞可安全应用于腹腔镜肾脏手术,麻醉药物用量少,患者苏醒迅速,术后疼痛轻。

Objective To evaluate the feasibility of ultrasound⁃guided spinal flat block in laparoscopic kidney surgery.Methods Sixty patients undergoing elective laparoscopic renal surgery were divided into two groups stochastically,with 30 cases in each group:erector spinae plane block combined with general anesthesia(group E)and general anesthesia alone(group C).Group E patients were first treated with 0.5%ropivacaine 30ml for lateral spinal nerve block.Perioperative vital signs,operation time,recovery time and the dosage of anesthetic drug of both groups were recorded.Visual Analogue Scale(VAS)scores at 1,6,12,24 and 48 h after operation were recorded and compared with those at rest and cough.Usage of remedied analgesic drug,the number of PCIA press in both groups were recorded.The incidence of adverse reactions after operation was observed.Results An⁃esthesia drug dosage and anesthesia waking time in group E were significantly lower than those in group C(P<0.05).Patients in group E had lower VAS scores in rest state at 6 h and 12 h after surgery(P<0.05),and VAS scores in cough state were significantly lower than those in group C at 1,6 and 12 h after surgery(P<0.05).The total of remediation analgesic drugs usage and PCIA compressions times were significantly reduced after surgery(P<0.05).There was not any obvious adverse reaction after operation in both groups.Conclusion Ultrasound⁃guided erector spinae plane block can be safely applied in laparoscopic kidney surgery,which can significantly re⁃duce the dosage of anesthetic drugs,shorten the waking time and alleviate postoperative pain.