超声引导下腹横肌筋膜阻滞配合喉罩通气全麻对腹腔镜胆囊手术患者苏醒质量及镇痛效果的影响

Influences of ultrasound-guided transversalis abdominis fascia block combined with laryngeal mask ventilation for general anesthesia on recovery quality and analgesia effect in patients undergoing laparoscopic gallbladder surgery

目的:探讨超声引导下腹横肌筋膜阻滞配合喉罩通气全麻对腹腔镜胆囊手术患者苏醒质量及镇痛效果的影响。方法:选择进行腹腔镜胆囊手术的80例患者,根据随机数表法将其分为观察组与对照组各40例,观察组给予超声引导下腹横肌筋膜阻滞配合喉罩通气全麻,对照组给予喉罩麻醉。比较两组患者围术期血流动力学指标、麻醉相关指标、应激指标和麻醉不良反应发生率。结果:两组麻醉诱导前心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO_(2))水平比较无统计学差异(均P>0.05),观察组手术开始时HR、MAP、SpO_(2)水平显著高于对照组(均P<0.05),拔除喉罩后15 min观察组HR显著高于对照组(P<0.05),而MAP、SpO_(2)水平与对照组比较无统计学差异(均P>0.05);观察组拔除喉罩即刻和拔除喉罩1 h后皮质醇和肾上腺素水平显著低于对照组(均P<0.05);观察组患者术中Ramsay评分显著高于对照组(P<0.05),苏醒1、4 h后视觉模拟评分(VAS)显著低于对照组(均P<0.05),两组苏醒24 h后VAS评分无统计学差异(P>0.05);观察组患者瑞芬太尼用量、术后苏醒时间、喉罩持续时间、复苏室停留时间显著低于对照组(均P<0.05);两组麻醉不良反应发生率比较无统计学差异(P>0.05)。结论:超声引导下腹横肌筋膜阻滞配合喉罩通气全麻对于腹腔镜胆囊手术患者麻醉效果良好,可显著缩短苏醒时间,减少苏醒后疼痛。

Objective:To explore the influences of ultrasound-guided transversalis fascia block combined with laryngeal mask ventilation for general anesthesia on recovery quality and analgesia effect in patients undergoing laparoscopic gallbladder surgery.Methods:A total of 80 patients undergoing laparoscopic gallbladder surgery were enrolled.According to random number table method,they were divided into observation group and control group,40 cases in each group.The observation group was given ultrasound-guided transversalis fascia block combined with laryngeal mask ventilation for general anesthesia,while control group was given laryngeal mask anesthesia.The perioperative hemodynamic indexes,anesthesia-related indexes,stress indexes and the incidence of adverse anesthesia reactions were compared between the two groups.Results:Before anesthesia induction,there was no significant difference in heart rate(HR),mean arterial pressure(MAP)or blood oxygen saturation(SpO_(2))between the two groups(all P>0.05).At the beginning of surgery,levels of HR,MAP and SpO_(2)in observation group were significantly higher than those in control group(all P<0.05).At 15 minutes after laryngeal mask removal,HR in observation group was significantly higher than that in control group(P<0.05),but there was no significant difference in MAP and SpO_(2)between the two groups(all P>0.05).Immediately and at 1 hour after laryngeal mask removal,the levels of cortisol and adrenaline in observation group were significantly lower than those in control group(all P<0.05).Ramsay score in observation group was significantly higher than that in control group during surgery(P<0.05),the scores of visual analogue scale(VAS)were significantly lower than those in control group at 1 and 4 hours after recovery(all P<0.05),but there was no significant difference in VAS score at 24 hours after recovery between the two groups(all P>0.05).The remifentanil dosage,postoperative recovery time,laryngeal mask duration and stay time in resuscitation room in observation group were significantly lower than those in control group(all P<0.05).There was no significant difference in the incidence of adverse anesthesia reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided transversalis fascia block combined with laryngeal mask ventilation for general anesthesia has good anesthesia effect in patients undergoing laparoscopic gallbladder surgery,which can significantly shorten recovery time and relieve pain after recovery.