超声引导下腹横肌平面阻滞复合瑞芬太尼靶控输注在胰管结石体外震波碎石术中的应用

Application of ultrasound-guided transversus abdominis plane block combined with target-controlled infusion of remifentanil in extracorporeal shock wave lithotripsy of pancreatic stones

目的评价超声引导下腹横肌平面阻滞复合瑞芬太尼靶控输注应用于胰管结石体外震波碎石术(ESWL)中的效果。方法选择60例首次接受ESWL治疗的胰管结石患者,随机分为R组和TR组,每组30例。R组患者仅接受瑞芬太尼靶控输注,TR组患者接受瑞芬太尼靶控输注前30 min行超声引导下腹横肌平面阻滞。采用Dixon序贯法计算两组患者的瑞芬太尼半数效应浓度(EC50),记录患者围手术期疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分、血流动力学参数、呼吸参数和不良反应。结果R组和TR组患者瑞芬太尼EC50分别为3.448ng/mL(95%CI 1.636~3.946 ng/mL)和2.523 ng/mL(95%CI 0.744~2.991 ng/mL),差异有统计学意义(P<0.05)。两组患者的VAS评分和Ramsay镇静评分相当(P均>0.05),血流动力学参数和呼吸参数差异均无统计学意义(P均>0.05)。TR组患者瘙痒发生率[6.7%(2/30)vs 26.7%(8/30),P=0.038]和总不良反应发生率[10.0%(3/30)vs 56.7%(17/30),P<0.001]低于R组。结论腹横肌平面阻滞复合瑞芬太尼靶控输注可为胰管结石ESWL提供满意的镇痛和镇静效果,减少术中瑞芬太尼用量,降低不良反应的发生率。

Objective To evaluate the effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with target-controlled infusion(TCI)of remifentanil in extracorporeal shock wave lithotripsy(ESWL)of pancreatic stones.Methods Sixty patients with pancreatic stones who received ESWL for the first time were randomly divided into R group and TR group(30 cases in each group).Patients in R group received TCI of remifentanil only,while patients in TR group received ultrasound-guided TAPB 30 min before TCI of remifentanil.Dixon’s up-and-down method was used to calculate the half maximum effective concentration(EC50)of remifentanil.Perioperativevisual analog scale(VAS),Ramsay sedation scale,hemodynamic parameters,respiratory parameters,and adverse events were also recorded.Results The EC50 of remifentanil were 3.448 ng/mL(95%confidence interval[CI]1.636-3.946 ng/mL)and 2.523 ng/mL(95%CI 0.744-2.991 ng/mL)in the R group and the TR group,respectively(P<0.05).The VAS score and the Ramsay sedation scale were comparable between the two groups(both P>0.05),and there were no significant differences in hemodynamics and respiratory parameters between the two groups(both P>0.05).Compared with the R group,the total incidence rate of adverse events was lower in the TR group(10.0%[3/30]vs 56.7%[17/30],P<0.001),and so was the incidence rate of itching(6.7%[2/30]vs 26.7%[8/30],P=0.038).Conclusion TAPB combined with TCI of remifentanil can provide satisfactory analgesia and sedation for ESWL of pancreatic stones,and can reduce the dosage of remifentanil,with less adverse events.