ESPB联合全麻对腹腔镜胆囊切除术术中药物控制及术后恢复的效果

Effect of ESPB Combined with General Anesthesia on Intraoperative Drug Control and Postoperative Recovery of Laparoscopic Cholecystectomy

目的 探讨竖脊肌平面阻滞(erector spinalis plane block,ESPB)联合全麻对腹腔镜胆囊切除术术中药物控制及术后恢复的效果。方法 随机选择2021年6月—2022年3月在云浮市人民医院进行腹腔镜胆囊切除术的患者40例,随机分为研究组、对照组。研究组20例采用超声引导ESPB联合气管插管全麻,对照组20例采用气管插管全麻。两组患者均采用相同的全麻诱导方案和术中维持用药。记录两组患者术中全麻药的用量、术毕清醒时间和拔管时间以及术后不同时间点(术后2 h、12 h、24 h)的视觉模拟评分法(VAS)评分和恶心呕吐发生率。结果研究组瑞芬太尼用量较对照组明显减少[(547.83±65.18)μg VS(717.53±82.21)μg],差异有统计学意义(t=7.234,P<0.001)。研究组术后2 h、12 h、24 h的VAS评分均低于对照组,差异有统计学意义(t=5.993、7.001、2.637,P<0.05)。研究组术后恶心呕吐发生率显著低于对照组,差异有统计学意义(χ^(2)=4.286,P=0.038)。结论 超声引导ESPB联合全麻用于腹腔镜胆囊切除术中,具有较好的术中术后镇痛效果,既可减少术中阿片类镇痛药物用量,又可减少患者术后疼痛和恶心呕吐的发生率,提高围术期患者的安全和舒适度。

Objective To investigate the effect of erector spinalis plane block(ESPB)combined with general anesthesia on intraoperative drug control and postoperative recovery during laparoscopic cholecystectomy.Methods Forty patients who underwent laparoscopic cholecystectomy in Yunfu People's Hospital from June 2021 to March 2022 were randomly selected and randomly divided into the study group and the control group.Ultrasound-guided ESPB combined with tracheal intubation was used for general anesthesia in twenty cases in the study group,and tracheal intubation was used for general anesthesia in twenty cases in the control group.The same general anesthesia induction protocol and intraoperative maintenance medication were used in both groups.The intraoperative dosage of general anesthetics,the time of awakening and removal of tracheal tube at the end of surgery,and the incidence of Visual Analogue Scale(VAS)score and nausea and vomiting at different postoperative time points(2 h,12 h and 24 h after surgery)were recorded in both groups.Results The amount of remifentanil in the study group was significantly lower than that in the control group[(547.83±65.18)μg vs(717.53±82.21)μg],the difference was statistically significant(t=7.234,P<0.001).The VAS scores at 2 h,12 h and 24 h postoperatively in the study group were lower than those in the control group,the difference was statistically significant(t=5.993,7.001,2.637,P<0.05).The incidence of postoperative nausea and vomiting in the study group was significantly lower than that in the control group,the difference was statistically significant(χ^(2)=4.286,P=0.038).Conclusion Ultrasound-guided ESPB combined with general anesthesia for laparoscopic cholecystectomy has a better intraoperative and postoperative analgesic effect,which can reduce the amount of intraoperative opioid analgesic drugs and also reduce the incidence of postoperative pain and nausea and vomiting in patients,and improve the safety and comfort of patients in the perioperative period.