老年患者腹腔镜肾切除术麻醉的优化策略:超声引导竖脊肌平面阻滞联合全凭静脉麻醉

Optimization strategy of anesthesia for laparoscopic nephrectomy in elderly patients:ultrasound-guided erector spinae plane block combined with total intravenous anesthesia

目的:评价超声引导竖脊肌平面阻滞联合全凭静脉麻醉对老年患者腹腔镜肾切除术麻醉的优化效果。方法:这是一项前瞻性随机对照研究。2023年4月至10月本院择期/限期拟行全凭静脉麻醉腹腔镜肾切除术老年患者70例,年龄60~80岁,BMI 22~30 kg/m^(2),ASA分级Ⅰ-Ⅲ级。采用随机数字表法分为全凭静脉麻醉组(TIVA组)和超声引导竖脊肌平面阻滞联合凭全静脉麻醉组(ESPB组),每组35例。两组采用相同全凭静脉麻醉方案,ESPB组全麻后在T 11水平实施超声引导竖脊肌平面阻滞,穿刺成功后注射0.3%罗哌卡因30 ml。术后24 h时行15项恢复质量量表(QoR-15)评分,记录术后补救镇痛和不良反应发生情况。 结果:与TIVA组相比,ESPB组QoR-15评分升高,术后补救镇痛率下降,不良反应发生率降低( P<0.05)。 结论:超声引导竖脊肌平面阻滞联合全凭静脉麻醉有利于腹腔镜肾切除术老年患者的术后转归。

Objective To evaluate the optimization strategy of anesthesia for laparoscopic nephrectomy in elderly patients using ultrasound-guided erector spinae plane block combined with total intravenous anesthesia.Methods This was a prospective randomized controlled study.Seventy elderly patients,aged 60-80 yr,with a body mass index of 22-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ,scheduled for elective/limited laparoscopic nephrectomy under total intravenous anesthesia in our hospital from April to October 2023,were divided into a total intravenous anesthesia group(TIVA group)and an ultrasound-guided erector spinae plane block combined with total intravenous anesthesia group(ESPB group)using a random number table method,with 35 cases in each group.Two groups used the same general anesthesia regimen.The ultrasound-guided erector spinae plane block was performed at the T 11 level after general anesthesia,and 0.3%ropivacaine 30 ml was injected after the successful puncture in ESPB group.The postoperative quality of recovery was assessed using the 15-item Quality-of-Recovery scale.The postoperative rescue analgesia and occurrence of adverse reactions were recorded.Results Compared with TIVA group,the 15-item Quality-of-Recovery scale score was significantly increased,the rate of postoperative rescue analgesia was decreased,and the incidence of adverse reactions was decreased in ESPB group(P<0.05).Conclusions Ultrasound-guided erector spinae plane block combined with total intravenous anesthesia is beneficial for the postoperative outcomes of elderly patients undergoing laparoscopic nephrectomy.