椎旁神经阻滞联合全麻与全麻对经皮肾镜取石术患者早期康复的影响比较

Comparison of the effects of paravertebral nerve block combined withgeneral anesthesia and general anesthesia on the early rehabilitation ofpatients undergoing percutaneous nephrolithotomy

目的比较椎旁神经阻滞联合全身麻醉(简称全麻)与全麻对经皮肾镜取石术患者早期康复质量的影响。方法选择择期行经皮肾镜取石术的患者120例,ASA分级Ⅰ—Ⅱ级,年龄20~70岁,体重指数(BMI)<35 kg/m^2。随机分为2组(n=60),即全麻组(G组)和椎旁神经阻滞联合全麻组(GP组)。G组常规麻醉诱导,GP组在麻醉诱导前先行椎旁神经阻滞。记录患者术前1 d(D1)及术后1 d(D2)、术后2 d(D3)时的术后恢复质量量表(QoR-40)评分,记录麻醉诱导前(T0)、麻醉诱导后10 min(T1)、碎石开始时(T2)、碎石开始后30 min(T3)、手术结束时(T4)、拔管后5 min(T5)2组患者的心率(HR)、平均动脉压(MAP)变化,丙泊酚和瑞芬太尼总用量,术后镇痛补救情况,术后2、6、12、24、48 h视觉模拟评分(VAS),记录术后恶心、呕吐发生率及患者术后最早下床时间、总费用、住院时间。结果与G组相比,GP组D2、D3的QoR-40量表总评分升高(P<0.05),在T2和T5时刻HR和MAP更加平稳(P<0.05),术中丙泊酚和瑞芬太尼总用量降低(P<0.05),术后补救镇痛率降低(P<0.05),术后2 h、6 h时VAS评分低(P<0.05),术后恶心、呕吐发生率低(P<0.05),患者术后下床时间早,费用更低,住院时间更短(P<0.05)。结论椎旁神经阻滞联合全麻比单独使用全麻更有利于经皮肾镜取石术患者早期康复。

Objective To compare the effects of paravertebral nerve block combined with general anesthesia and general anesthesia on the early recovery quality of patients undergoing percutaneous nephrolithotomy.Methods A total of 120 patients,ASA gradesⅠ-Ⅱ,aged 20-70 years,and body mass index(BMI)<35 kg/m^2 who were scheduled for elective percutaneous nephrolithotomy were selected.They were randomly divided into two groups(n=60):a general anesthesia group(group G),and a paravertebral nerve block group combined with general anesthesia group(group GP).Group G received routine anesthesia,while group GP underwent paravertebral nerve block before anesthesia induction.The QoR-40 scale scores were recorded one day before surgery(D1),one day after surgery(D2),and two days after surgery(D3).The changes of heart rate(HR)and mean arterial pressure(MAP)in the two groups were recorded before anesthesia induction(T0),10 min after anesthesia induction(T1),and at the beginning of stone removal were recorded(T2),30 min after the beginning of stone removal(T3),at the end of surgery(T4),and 5 min after extubation(T5).The total dosage of propofol and remifentanil,postoperative analgesia remedy,and the Visual Analogue Score(VAS)2 h,6 h,12 h,24 h and 48 h after surgery were recorded.The incidence of postoperative nausea and vomiting,and postoperative bedtime,total expense,and discharge time were recorded.Results Compared with group G,group GP presented remarkable increases in the total score of QoR-40 on D2 and D3(P<0.05),more stable HR and MAP at T2 and T5(P<0.05),remarkable decreases in the total dosage of propofol and remifentanil(P<0.05),decreases in the incidence of postoperative analgesic remedy(P<0.05),decreases in the VAS score 2 h and 6 h after operation(P<0.05),decreases in the incidence of nausea and vomiting(P<0.05),with shorter bedtime,lower expense,and earlier discharge time(P<0.05).Conclusions Paravertebral nerve block combined with general anesthesia is superior to general anesthesia in the early rehabilitation of patients undergoing percutaneous nephrolithotomy.