竖脊肌平面阻滞对老年患者经尿道前列腺电切术后苏醒质量及谵妄的影响

Effects of erector spinae plane block on recovery quality and postoperative delirium in elderly patients undergoing transurethral resection of prostate

目的探讨竖脊肌平面阻滞(ESPB)对老年患者经尿道前列腺电切术后苏醒质量及谵妄的影响。方法选择2021年3-9月择期行经尿道前列腺电切术的老年患者60例,采用随机数字表法分为两组:对照组(C组)和竖脊肌平面阻滞组(E组),每组30例。所有患者均予以气管插管全身麻醉,E组患者在麻醉诱导前行超声引导ESPB,C组不予神经阻滞。所有患者术后均予以静脉自控镇痛泵(PCIA)镇痛。记录术中丙泊酚、瑞芬太尼的用量、术后苏醒时间、拔管时间及拔管后10 min躁动(SAS)评分;记录术后2、24及48 h视觉模拟疼痛(VAS)评分、术后PCIA按压次数及补救性镇痛情况;记录术后3 d内谵妄的发生情况及不良事件(局部麻醉药中毒、血肿、皮肤瘙痒、术后恶心呕吐)情况。结果与C组相比,E组患者术中丙泊酚、瑞芬太尼使用量明显减少,差异有统计学意义(P<0.05);E组患者术后苏醒时间及拔管时间均较C组明显缩短(P<0.05);与C组相比,E组患者拔管后10 min时SAS评分明显降低(P<0.05);E组患者术后2 h及24 h VAS评分均较C组低(P<0.05),而48 h VAS评分两组间差异无统计学意义(P>0.05)。E组患者术后PCIA按压次数及行补救性镇痛例数均较C组少(P<0.05);E组患者术后3 d谵妄的发生率明显低于C组(6.7%vs.30%,P<0.05)。两组患者术后瘙痒、恶心及呕吐发生率差异无统计学意义(P>0.05),均未发生严重不良事件。结论竖脊肌平面阻滞可提高老年患者前列腺电切术后苏醒质量,减少术后谵妄的发生率,术后镇痛效果佳,安全性高。

Objective To explore the effects of erector spinae plane block(ESPB)on the quality of postoperative recovery and delirium in elderly patients undergoing transurethral resection of prostate(TURP).Methods Sixty patients with elective TURP from March 2021 to September 2021 were selected and divided into two groups according to the random number table method:the control group(group C)and ESPB group(group E),30 cases in each group.All patients conducted endotracheal intubation and general anesthesia.The group E performed the ultrasound guidance ESPB before anesthesia induction.The group C was not given the nerve block.All patients were given the patient-controlled intravenous analgesia(PCIA)pump for analgesia after operation.The dosage of propofol,remifentanil during operation,time of postoperative awakening,tracheal extubation time and the sedation-agitation scores(SAS)at 10 min after extubation were recorded.The visual analogue score(VAS)scores at postoperative 2,24,48 h were recorded,the number of PCIA press and remedy analgesia were recorded.The delirium occurrence within postoperative 3 d and the adverse effects(local anesthetic drug intoxication,hematoma,skin pruritus,postoperative nausea and vomiting)were recorded.Results Compared with group C,the intraoperative propofol and remifentanil amounts in the group E were significantly decreased,and the differences were statistically significant(P<0.05).The postoperative recovery time and tracheal extubation time in the group E were significantly shortened compared with the group C(P<0.05).Compared with the group C,the SAS score at 10 min after extubation in the group E was signifi-cantly decreased(P<0.05).The VAS scores at postoperative 2,24 h in the group E were lower than those in the group C(P<0.05),while the VAS score at 48 h had no statistical difference between the two groups(P>0.05).The number of postoperative PCIA pump press and the number of the patients requiring remedy analgesia in the group E were less than those in the group C(P<0.05).The incidence rate of delirium within postoperative 3 d in the group E was significantly lower than that in the group C(6.7%vs.30%,P<0.05).There was no statistical difference in the incidence rates of postoperative pruritus,nausea and vomiting be-tween the two groups(P>0.05),and no severe adverse events occurred in both groups.Conclusion ESPB in elderly patients undergoing TURP could improve the quality of postoperative awakening,reduce the incidence rate of postoperative delirium with good postoperative analgesic effect and high safety.