超声引导下腹直肌鞘神经阻滞在腹膜透析管植入术中的应用

摘要

目的 观察超声引导下腹直肌鞘神经阻滞在终末期肾病患者腹膜透析管植入术中的麻醉效果.方法 选择择期行腹膜透析管置入术终末期肾病患者75例,男38例,女37例,年龄18~65岁,BMI 18.5~24.0 kg/m2,ASA Ⅲ级,采用随机数字法分为三组,A组:全身麻醉组,麻醉方法为全凭静脉麻醉;B组:腹直肌鞘神经阻滞组,手术侧腹直肌鞘内注射0.5% 罗哌卡因15 ml;C组:局部浸润麻醉组,1% 利多卡因+0.5% 罗哌卡因在手术切口和手术路径进行局部浸润麻醉.记录入室时(T0)、麻醉诱导后10 min(T1)、手术开始即刻(T2)、手术开始后20 min(T3)、手术结束时(T4)的 HR和 MAP.记录患者术后2、4、8、12、24 h运动 VAS评分、Ramsay镇静评分,记录手术时间和不良反应.结果 与 T0时比较,T1~T3时 A 组 HR 明显减慢、MAP 明显降低(P<0.05);T2、T3时C组 HR明显增快、MAP明显升高(P<0.05);B组不同时点 HR和MAP差异无统计学意义.与T1时比较,T2、T3时C组 HR明显增快、MAP 明显升高(P<0.05),与 T2、T3时比较,T4时C组 HR明显减慢、MAP明显降低(P<0.05).术后2、4、8、12、24 h B组运动 VAS评分明显低于 A组和C组(P<0.05).C组术中总体补救镇痛次数明显多于B组(P<0.05).A组和 B组手术时间明显短于C组(P<0.05).三组均未发生不良反应.结论 超声引导下腹直肌鞘神经阻滞在终末期肾病患者腹膜透析管植入术中麻醉效果确切、无不良反应,值得在临床推广.%Objective To observe anesthetic effects of ultrasound-guided rectus sheath block (RSB)in peritoneal dialysis catheter implantation in patients with end-stage renal disease. Methods A total of 75 uremic patients (38 males,37 females,aged 18-65 years,BMI 18.5-24 kg/m2,ASA physical status Ⅲ),scheduled for elective peritoneal dialysis catheterization,were randomly divided into three groups (n=25 each)using a random number table:group A:total intra-venous anesthesia;group B:rectus sheath block,0.5% ropivacaine 15 ml were injected into the lat-eral rectus sheath;group C:local infiltration anesthesia was performed with 1% lidocaine and 0.5% ropivacaine.The mean arterial pressure and heart rate at the point of entering the operating room (T0),10 min after anesthesia induction (T1),at the beginning of operation (T2),20 min after the beginning of operation(T3),and at the end of the operation(T4)were recorded.The VAS score and Ramsay score at 2,4,8,12,24 h after surgery were recorded.The duration of operation and the oc-currence of adverse reactions were recorded.Results In group A,compared with T0,MAP and HR at T1-T3decreased significantly (P<0.05).In group B,there were no difference among T0-T4.In group C,compared with T0,T1and T4,MAP and HR at T2,T3increased significantly(P<0.05). Compared with group C,the duration of operation time in group A and group B decreased significantly (P<0.05).Compared with group A and group C,the VAS score at each point of group B was lower (P<0.05).Compared with group B,the total number of remediation analgesia in group C increased significantly(P<0.05).There was no adverse reaction in all three groups.Conclusion Ultra-sound-guided rectus sheath block anesthesia is safe and effective in peritoneal dialysis catheter implanta-tion patients with end-stage renal disease,and is worthy of clinical promotion.