超声引导下胸椎旁神经阻滞复合全身麻醉在后腹腔镜肾脏手术中的应用对减少并发症发生率的价值分析

The Value of Ultrasound-guided Paravertebral Nerve Block Combined with General Anesthesia in Retroperitoneal Laparoscopic Renal Surgery to Reduce the Incidence of Complications

目的探讨超声引导胸椎旁神经阻滞(TPVB)复合全身麻醉用于后腹腔镜肾脏手术中的意义。方法随机选取厦门长庚医院和漳州市医院2017年9月—2020年6月收治的70例全麻下腹腔镜肾脏手术患者采用随机数表法分为对照组(全身麻醉+TPVB时仅给予生理盐水作为安慰剂)和观察组(全身麻醉+TPVB时给予罗哌卡因和右美托咪定)。记录T0~T5两组SBP、MAP、HR和术后1、6、12、24 h疼痛视觉模拟评分法(VAS)分值,对比两组镇痛满意评分、镇痛持续时间、瑞芬太尼用量和并发症。结果T0、T1时两组SBP、MAP、HR比较,差异无统计学意义(P>0.05);T2~T5时两组SBP、MAP、HR均较T0降低,但观察组较对照组高,差异有统计学意义(P<0.05);术后1、6、12 h观察组VAS分值较对照组低,差异有统计学意义(t=22.599、17.764、17.235,P<0.05);两组镇痛满意评分比较,差异无统计学意义(P>0.05);观察组镇痛持续时间为(9.11±1.65)min,对照组为(7.78±1.24)min,差异有统计学意义(t=3.812,P<0.05);观察组瑞芬太尼用量为(344.65±89.62)μg,对照组为(1298.65±223.32)μg,差异有统计学意义(t=23.455,P<0.001);观察组并发症发生率为25.71%,对照组为42.86%,差异无统计学意义(P>0.05)。结论超声引导TPVB复合全身麻醉用于后腹腔镜肾脏手术中具有满意镇痛效果,能缓解术后疼痛,安全性高,不增加并发症发生率。

Objective To explore the significance of ultrasound-guided TPVB combined with general anesthesia in retroperitoneal laparoscopic renal surgery.Methods Seventy patients undergoing laparoscopic kidney surgery under general anesthesia in Xiamen Changgeng Hospital and Zhangzhou Hospital from September 2017 to June 2020 were randomly selected and divided into control group(general anesthesia+only normal saline was given as placebo)and observation group(general anesthesia+TPVB,ropivacaine and dexmedetomidine)by random number table method.SBP,MAP,HR and visual analogue scale(VAS)scores at 1,6,12 and 24 h after operation were recorded from T0 to T5 between the two groups.Satisfaction score,duration of analgesia,dosage of remifentanil and complications were compared between the two groups.Results There was no statistically significant difference in SBP,MAP,HR between the two groups at T0 and T1(P>0.05).SBP,MAP and HR of the two groups were lower than T0 at T2-T5,but the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).The VAS scores of the observation group were lower than those of the control group at 1,6 and 12,24 hours after operation,and the difference was statistically significant(t=22.599,17.764,17.235,P<0.05).There was no statistically significant difference in analgesia satisfaction score between the two groups(P>0.05).The duration of analgesia was(9.11±1.65)min in the observation group and(7.78±1.24)min in the control group,the difference was statistically significant(t=3.812,P<0.05).The dosage of remifentanil in the observation group was(344.65±89.62)μg and the control group was(1298.65±223.32)μg,the difference was statistically significant(t=23.455,P<0.001).The complication rate in the observation group was 25.71%and that in the control group was 42.86%,the difference was not statistically significant(P>0.05).Conclusion Ultrasound guided TPVB combined general anesthesia used in retroperitoneal laparoscopic renal surgery has a satisfactory analgesic effect,can relieve postoperative pain,is safe,and does not increase complications rate.