全身麻醉联合超声引导下竖脊肌平面阻滞在腹腔镜胆囊手术中的效果及对患者血流动力学的影响

Efficacy of erector spinae plane block guided by general anesthesia combined with ultrasound in laparoscopic cholecystectomy and its impact on hemodynamics of patients

目的探讨全身麻醉联合超声引导下竖脊肌平面阻滞在腹腔镜胆囊手术中的效果及对患者血流动力学的影响。方法选取2021年10月至2022年3月新疆生产建设兵团第十三师红星医院收治的90例择期行腹腔镜胆囊手术患者作为研究对象,应用随机数表法分为联合组与全麻组,每组各45例。全麻组患者进行静吸联合全身麻醉,联合组患者进行全身麻醉联合超声引导下竖脊肌平面阻滞,比较两组患者术后恢复质量,麻醉前、麻醉后和手术结束时的血流动力学指标,苏醒后1 h和苏醒后1 d的疼痛程度与舒适度。结果两组患者恢复室停留时间、拔出气管导管时间、意识恢复时间比较,差异无统计学意义(P>0.05),联合组麻醉苏醒躁动发生率低于全麻组,差异有统计学意义(P<0.05);联合组麻醉后平均动脉压(MAP)高于全麻组,且手术结束时心脏指数(CI)、心率(HR)高于全麻组,差异均有统计学意义(P<0.05);联合组苏醒后1 h、苏醒后1 d的运动视觉模拟疼痛量表(VAS)评分和静息VAS评分低于全麻组,差异有统计学意义(P<0.05),且苏醒后1 d的运动VAS评分和静息VAS评分高于苏醒后1 h,联合组苏醒后1 h、苏醒后1 d的舒适度评分(BCS)高于全麻组,且苏醒后1 d BCS评分低于苏醒后1 h,差异有统计学意义(P<0.05)。结论对腹腔镜胆囊手术患者采取全身麻醉联合超声引导下竖脊肌平面阻滞能够进一步提升患者术后恢复质量,减轻术中血流动力学反应,减轻患者术后疼痛程度,提升舒适度,且安全性更高,值得临床推广应用。

Objective To investigate the efficacy of erector spinae plane block guided by general anesthesia combined with ultrasound in laparoscopic cholecystectomy and its impact on hemodynamics of patients.Methods A total of 90 patients undergoing elective laparoscopic cholecystectomy from October 2021 to March 2022 admitted to and treated in the 13th Division Red Star Hospital of Xinjiang Production and Construction Corps were selected as the research objects,and they were divided into the combined group(n=45)and the general anesthesia group(n=45)according to the random number table method.Patients in the general anesthesia group underwent s tatic suction compound general anesthesia,while those in the com bined group were treated with general anesthesia combined with ultrasound-guided erector spinae plane block.The postoperative recovery quality,hemodynamic indices before anesthesia,after anesthesia and in the end of operation,and the degrees of pain and comfort at 1 hour and 1 d after awakening were compared between the two groups of patients.Results There were no statistically significant differences between the two groups of patients in the time of stay in the recovery room,the time of pulling out endotracheal tube and the time of consciousness recovery(P>0.05).The incidence of restlessness after anesthesia in the combined group was lower than that in the general anesthesia group,with statistically significant difference(P<0.05).After anesthesia,mean arterial pressure(MAP)in the combined group was higher than that in the general anesthesia group,and cardiac index(CI)and heart rate(HR)in the end of operation were higher than those in the general anesthesia group,all with statistically significant differences(P<0.05).The scores of motor visual analogue scale(VAS)and resting VAS in the combined group at 1 hour and 1 d after awakening were lower than those in the general anesthesia group,with statistically significant differences(P<0.05).Meanwhile,the scores of motor VAS and resting VAS at 1 d after awakening were higher than those at 1 hour after awakening;The bruggrmann comfort scale(BCS)scores at 1 hour and 1 d after awakening in the combined group were higher than those in the general anesthesia group,and the scores of BCS at 1 d after awakening were lower than those at 1 hour after awakening,with statistically significant differences(P<0.05).Conclusion For patients undergoing laparoscopic cholecystectomy,general anesthesia combined with ultrasound guided erector spinae plane block can further improve the quality of patients’postoperative recovery,reduce the intraoperative hemodynamic response,reduce the patients’postoperative pain degree,and improve the BCS score,with higher safety.Therefore,it is worthy of clinical application and promotion.