超声引导腹直肌后鞘阻滞在经脐单孔腹腔镜手术患者中加速康复的临床观察

Clinical observation of ultrasound-guided posterior sheath block of rectus abdominis in enhanced recovery of patients undergoing transumbilical single-port laparoscopic surgery

目的观察超声引导腹直肌后鞘阻滞在经脐单孔腹腔镜手术患者中加速康复的效果。方法选择2019年9月至2020年9月东莞市清溪医院择期经脐单孔腹腔镜手术治疗异位妊娠、卵巢囊肿患者90例为研究对象。将手术患者按照随机数字表法分成A、B、C三组。均用相同麻醉方案行全身麻醉,A组术后给予静脉镇痛泵:舒芬太尼150μg+托烷司琼10 mg配至100 ml。B组手术结束后行超声引导(索诺声便携式超声M-TURBO)双侧腹直肌后鞘阻滞,每侧0.25%罗哌卡因20 ml。C组手术结束时直接0.25%罗哌卡因切口局部注射。疼痛补救均采用西乐葆200 mg口服。比较观察各组术后生命体征变化、镇痛效果、静脉泵按压次数或疼痛补救次数、不良反应和术后下地活动时间,所有数据采SPSS20软件分析,探讨最优镇痛模式。结果术后0 h三组患者的MAP、HR组间比较,差异无统计学意义(P>0.05),三组患者在术后2 h、6 h时的MAP、HR较拔管后显著下降,其中B组术后2 h、6 h的HR均高于A、C两组,MAP低于A、C两组,差异有统计学意义(P<0.05);术后即刻0 h、2 h、4 h、三组患者的VAS评分比较,差异无统计学意义(P>0.05),而在术后8 h、12 h、24 h时,A、B组VAS评分水平明显低于C组,差异有统计学意义(P<0.05),但与A组与B组间比较,差异无统计学意义(P>0.05);B组不良反应发生率较A、C两组明显减少,差异有统计学意义(P<0.05),但VAS评分与A组相比差别不大;另外B组术后下地活动时间较A、C两组明显缩短,差异有统计学意义(P<0.05)。结论利用超声引导腹直肌后鞘阻滞在经脐单孔腹腔镜手术患者中,较既往依靠解剖和手感定位的穿刺技术而言,安全,精准,损伤小,可使患者提前下床活动,符合目前加速康复外科理念,节约医疗资源。

Objective To observe the efficacy of ultrasound-guided posterior sheath block of rectus abdominis in enhanced recovery of patients undergoing transumbilical single-port laparoscopic surgery.Methods A total of 90 patients with ectopic pregnancy and ovarian cyst treated with transumbilical single-port laparoscopic surgery admitted to Dongguan Qingxi Hospital from September 2019 to September 2020 were selected as the research objects.Patients were divided into group A,group B and group C according to random number table.All patients were treated with general anesthesia with the same anesthesia scheme.Group A was treated with intravenous analgesia pump after operation(sufentanil 150 ug combined with tropisetron 10 mg was prepared to 100 ml).Group B was treated with ultrasound-guided(Sonosite portable ultrasound M-TURBO)bilateral posterior sheath block of rectus abdominis muscle after operation,with 0.25%ropivacaine 20 ml on each side.Group C was treated with 0.25%ropivacaine topical injection through incision at the end of operation.Celebrex 200 mg was administrated orally for pain relief.The changes of vital signs,analgesia effect,times of intravenous pump pressing or pain relief,adverse reactions(ADRs)and postoperative time of off-bed activity in each group were compared and observed.And all the data were analyzed by SPSS20 software to investigate the optimal analgesia model.Results There were no statistically significant differences in MAP and HR among the three groups of patients at 0 h after operation(P>0.05).However,MAP and HR of the three groups of patients decreased significantly at 2 h and 6 h after operation compared with those after extubation.Among them,HRs of group B at 2 h and 6 h after operation were both higher than those of group A and C,and MAPs were both lower than those of group A and C,with statistically significant differences(P<0.05).There were no statistically significant differences in VAS scores among the three groups of patients at baseline 0 h,2 h and 4 h after operation(P>0.05).While at 8 h,12 h and 24 h after operation,the VAS score levels in group A and B were significantly lower than those in group C,with statistically significant differences(P<0.05).However,there was no statistically significant difference between group A and B(P>0.05).The incidence of ADRs in group B was significantly lower than those in group A and C,with statistically significant differences(P<0.05),while the VAS score was not significantly different from that in group A.In addition,the postoperative time of off-bed activity in group B was significantly shorter than those in group A and C,with statistically significant difference(P<0.05).Conclusion Ultrasound-guided posterior sheath block of rectus abdominis in patients undergoing transumbilical single-port laparoscopic surgery is safer,more accurate and less invasive than previous puncture techniques relying on anatomy and hand positioning,which can enable patients to perform off-bed activity earlier.It conforms to the current concept of enhanced recovery after surgery and saves medical resources.