超声引导下椎旁阻滞对机器人辅助腹腔镜肾切除术患者术后肺功能的影响

Effect of ultrasound-guided paravertebral block on postoperative pulmonary function in patients undergoing robot-assisted laparoscope nephrectomy

目的探讨超声引导下椎旁阻滞对机器人辅助腹腔镜肾切除术患者术后肺功能的影响。方法选择择期行机器人辅助腹腔镜肾切除术患者80例,男40例,女40例,年龄30~70岁,BMI 18.5~35.0 kg/m^(2),ASAⅠ或Ⅱ级。根据随机数字表法将患者分为两组:椎旁阻滞联合全麻组(PG组)和单纯全麻组(SG组),每组40例。两组术后均使用羟考酮静脉镇痛。记录术前1 d、术后1~5 d的用力肺活量(FVC)、第1秒用力呼气容量(FEV_(1))、最大呼气中期流量(MMEF)和SpO_(2)。记录术后1~5 d静息和活动(咳嗽)时VAS疼痛评分。记录丙泊酚用量、瑞芬太尼用量,镇痛泵有效按压次数、总按压次数和补救镇痛例数。记录术后首次下床活动时间、术后首次肛门排气时间、术后住院时间和不良反应的发生情况。记录术后5 d肺部并发症和术后30 d再次住院的发生情况。结果与术前1 d比较,术后1~5 d两组FVC、FEV_(1)及MMEF均明显降低(P<0.05),PG组术后1~4 d、SG组术后1~5 d SpO_(2)明显降低(P<0.05)。与SG组比较,PG组术后1~3 d FVC、术后1~5 d FEV_(1)和术后1~4 d MMEF、术后1~3 d SpO_(2)明显升高(P<0.05),术后1~2 d静息和活动时VAS疼痛评分明显降低(P<0.05),丙泊酚和瑞芬太尼用量、镇痛泵有效按压次数、总按压次数及补救镇痛率明显减少(P<0.05),术后首次下床活动时间、术后首次肛门排气时间和术后住院时间明显缩短(P<0.05),术后不良反应发生率和术后5 d的肺部并发症发生率明显降低(P<0.05)。结论超声引导下椎旁阻滞可为机器人辅助腹腔镜肾切除术患者提供更好的术后早期镇痛,改善术后肺功能,降低肺部并发症发生率。

Objective To investigate the effect of ultrasound-guided paravertebral block on postoperative pulmonary function in patients undergoing robot-assisted laparoscope nephrectomy.Methods Eighty patients,40 males and 40 females,aged 30-70 years,BMI 18.5-35.0 kg/m^(2),ASA physical stasusⅠorⅡ,undergoing robot-assisted laparoscope nephrectomy were selected.According to the random number table method,they were divided into two groups:paravertebral block combined with general anesthesia group(group PG)and simple general anesthesia group(group SG),40 patients in each group.Postoperative oxycodone intravenous analgesia was used in both groups.Forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),maximal mid-expiratory flow(MMEF)and SpO_(2)of the two groups at one day before surgery and 1 to 5 days after surgery were recorded.The VAS scores at rest and movement(coughing)from 1 to 5 days after surgery were recorded.The dosage of propofol and remifentanil,the number of total and effective compressions of the analgesic pump,and the number of remedial analgesia were recorded.First get out of bed time,anal exhaust time,length of postoperative hospital stay and the occurrence of adverse reactions were recorded.Pulmonary complications during 5 days after surgery,and re-hospitalization during 30 days after surgery were recorded.Results Compared with 1 day before surgery,FVC,FEV_(1)and MMEF at 1 to 5 days after surgery in the two groups,SpO_(2)at 1 to 4 days after surgery in group PG and 1 to 5 days after surgery in group SG were significantly decreased(P<0.05).The FVC from 1 to 3 days after surgery,FEV_(1)from 1 to 5 days after surgery and MMEF from 1 to 4 days after surgery in group PG were significantly higher than those in group SG(P<0.05).SpO_(2)in group PG was higher than that in group SG from 1 to 3 days after surgery(P<0.05).The VAS scores at rest and movement from 1 to 2 days after surgery in group PG was significantly lower than that in group SG(P<0.05).The dosage of propofol and remifentanil,the number of effective presses,total presses and remedial analgesia in group PG was significantly reduced than that in group SG(P<0.05).Compared with group SG,the first time of getting out of bed,the first time of anal exhaust,and the length of hospital stay in group PG were significantly shortened(P<0.05),and the incidence of postoperative adverse reactions and pulmonary complications 5 days after surgery were significantly reduced(P<0.05).Conclusion Ultrasound-guided paravertebral block can provide better early postoperative analgesia for patients undergoing robot-assisted laparoscopic nephrectomy,improve postoperative pulmonary function,and reduce the incidence of pulmonary complications.