B超引导下神经阻滞联合镇痛在经皮肝穿胆管引流术后的临床观察

Clinical Observation of Nerve Block Combined with Analgesia Under the Guidance of B-ultrasound After Percutaneous Transhepatic Bile Duct Drainage

目的探讨B超引导下神经阻滞联合镇痛在经皮肝穿胆管引流术后的临床观察。方法选择2020年1月-2021年12月来广西来宾市人民医院行经皮肝穿胆管引流术患者44例,根据随机数字表法分为试验组与对照组,观察组予以B超引导下神经阻滞联合术后静脉镇痛泵,对照组予以术后静脉镇痛泵麻醉诱导,记录并对比两组呼吸功能指标、术中指标、术后3h、12h、24h疼痛评分、不良反应发生情况。结果T_(2)时观察组PaO_(2)较对照组明显升高(P<0.05);其他各时点观察组、对照组两组PaO_(2)、PaCO_(2)、MAP、CVP组内、组间比无差异(P>0.05),与对照组相比,观察组手术出血量、手术时间及自按键总次数较低(P<0.05),两组患者拔管时间对比无差异学意义(P>0.05)。与对照组相比,观察组手术后3、12、24h的VAS评分较低(P<0.05)。观察组不良反应发生率9.09%(2/22)与对照组18.18%(4/22)进行比对无差异(P>0.05)。结论与常规麻醉相比,B超引导下神经阻滞联合镇痛更明显减轻患者术后疼痛,改善呼吸功能,降低术后并发症发生率,是一种安全有效的麻醉方案。

Objective To investigate the clinical observation of nerve block combined with analgesia guided by B ultrasound in percutaneous transhepatic bile duct drainage.Methods Forty-four patients who underwent percutaneous transhepatic bile duct drainage in our hospital from January 2020 to December 2021 were randomly divided into two groups,the experimental group and the control group according to the random number table method.The observation group received nerve block under the guidance of B-ultrasound combined with postoperative intravenous analgesia pump,and the control group received anesthesia induction with postoperative intravenous analgesia pump.Respiratory function index,intraoperative index,pain score at 3h/12h/24h after operation and incidence of adverse reactions were recorded and compared between the two groups.Results PaO_(2) in the observation group was significantly higher than that in the control group at T2(P<0∙05).There were no differences in PaO_(2),PaCO_(2),MAP and CVP between the observation group and the control group at other time points(P>0.05).Compared with the control group,the operative blood loss,operative time and total times of self-pressing were lower in the observation group(P<0.05),and there was no significant difference in extubation time between the two groups(P>0.05).Compared with the control group,VAS scores of the observation group were lower at 3,12 and 24h after operation(P<0.05).There was no difference in the incidence of adverse reactions between the observation group(9.09%,2/22)and the control group(18.18%,4/22)(P>0.05).Conclusion Compared with conventional anesthesia,nerve block combined with analgesia guided by B ultrasound can significantly relieve postoperative pain,improve respiratory function and reduce the incidence of postoperative complications,which is a safe and effective anesthesia program.