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医药导报  2018, Vol. 37 Issue (1): 63-66    DOI: 10.3870/j.issn.1004-0781.2018.01.016
  药物与临床 本期目录 | 过刊浏览 | 高级检索 |
罗哌卡因竖脊肌神经阻滞辅助全身麻醉用于腰椎手术30例
余奇劲1(),郭咸希2
1.武汉大学人民医院 麻醉科,武汉 430060
2.武汉大学人民医院 药学部,武汉 430060
Ropivacaine Erector Spinae Plane Block Assisting General Anesthesia in Lumbar Spine Surgery of 30 Cases
Qijing YU1(),Xianxi GUO2
1.Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,China
2.Department of Pharmacy,Renmin Hospital of Wuhan University,Wuhan 430060,China
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摘要 

目的 观察罗哌卡因竖脊肌神经阻滞辅助全身麻醉用于腰椎手术的临床效果。方法 择期全身麻醉下行腰椎手术的男性患者60例,随机分为竖脊肌神经阻滞组(E组)和对照组(C组)(n=30)。C组直接全凭静脉麻醉,E组于切皮前行 0.375%罗哌卡因竖脊肌阻滞。记录手术中患者生命体征、手术节段、手术时间、麻醉时间、麻醉药物用量及手术者对肌肉松弛的满意度。手术后4,8,24,48 h时行视觉模拟评分(VAS),并记录手术后48 h内补救镇痛药物使用情况、患者自控静脉镇痛(PCIA)按压次数、恶心呕吐等并发症和患者对麻醉满意程度情况。结果 两组患者手术中生命体征、手术节段、手术时间、麻醉时间及手术后并发症等均差异无统计学意义(均P>0.05)。C组和 E组丙泊酚用量分别为(1 526.2±134.5),(1 305.8±212.8) mg;瑞芬太尼用量分别为(2 452.2±232.5),(2 076.8±311.6) μg;苯磺顺阿曲库铵用量分别为(31.8±4.2),(22.3±5.1) mg(P<0.05 或P<0.01)。手术者对E组手术区域肌肉松弛满意度明显提高(P<0.05)。E组手术后 4,8 h静息切口VAS评分均显著降低(均P<0.01),手术后48 h内补救镇痛药物使用次数(或总量)和 PCIA按压次数均显著减少(P<0.01),患者对麻醉的满意程度明显提高(P<0.01)。结论 罗哌卡因竖脊肌神经阻滞辅助全身麻醉用于腰椎手术,可以减少围手术期全身麻醉药物用量和手术后补救镇痛药物使用次数及PCIA的按压次数,提高手术中手术医生和手术后患者麻醉满意度。

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余奇劲
郭咸希
关键词 罗哌卡因竖脊肌神经阻滞患者自控静脉镇痛    
Abstract

Objective To observe the clinical effect of ropivacaine erector spinae plane block assisting general anesthesia in lumbar spine surgery. Methods A total of 60 cases of male patients with selective lumbar spine surgery under general anesthesia were chosen and randomly divided into control group(group C) and erector spinae plane block group(group E)(n= 30).Group C was directly treated with total intravenous anesthesia.In group E,the erector spinae were blocked with 0.375% ropivacaine before skin incision.The patient's vital signs during operative period were recorded,as well as the operation time,anesthesia time,drug dosage and satisfaction of muscle relaxation .Postoperative VAS scores at 4,8,24 and 48 h were recorded.Remedied analgesic drug use,the number of PCIA press,complications such as nausea and vomiting,patients’ satisfaction degree within 48 h of postoperative were all recorded. Results There were no statistical difference in the vital signs,operation section,operation time,anesthesia time and postoperative complications(all P>0.05) in two groups. Compared with group C,the dosage of propofol,rifentanyl and benzene sulfonate in group E were significantly reduced .In group C and group E,dosage of propofol was(1 526.2±134.5) mg and(1 305.8±212.8) mg; dosage of remifentanil was(2 452.2±232.5) μg and(2 076.8±311.6) μg; dosage of benzene sulfonate was(31.8±4.2) mg and (22.3±5.1) mg]( P<0.05 or P<0.01) .Satisfaction of muscle relaxation in the operation area of group E was significantly increased(P<0.05).The VAS scores at 4 h and 8 h after operation in group E were all significantly reduced(P<0.01).In group E,the frequency(or total) of remediation analgesic drugs usage and PCIA compressions times were significantly reduced in 48 h after surgery(P<0.01).The satisfaction degree of the patients in group E was significantly increased(P<0.01). Conclusion Ropivacaine erector spinae plane block assisting general anesthesia in lumbar spine surgery can reduce perioperative general anesthesia drug dosage,the number of postoperative remediation of analgesic drugs,PCIA compressions times,and can improve satisfaction of operative doctors and patients with anesthesia.

Key wordsRopivacaine    Erector spinae plane block    Patient control intravenous analgesia
收稿日期: 2017-07-25      出版日期: 2018-01-05
引用本文:   
余奇劲,郭咸希. 罗哌卡因竖脊肌神经阻滞辅助全身麻醉用于腰椎手术30例[J]. 医药导报, 2018, 37(1): 63-66.
Qijing YU,Xianxi GUO. Ropivacaine Erector Spinae Plane Block Assisting General Anesthesia in Lumbar Spine Surgery of 30 Cases. Herald of Medicine, 2018, 37(1): 63-66.
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http://www.yydbzz.com/CN/10.3870/j.issn.1004-0781.2018.01.016      或      http://www.yydbzz.com/CN/Y2018/V37/I1/63
组别 年龄/
体质量/
kg
ASA分级/例
Ⅰ级 Ⅱ级
C组 47.3±15.2 58.3±11.4 4 25
E组 48.7±12.6 60.1±14.7 7 22
表1  两组患者年龄、体质量及ASA分级比较
组别与时间 HR/
(次·min-1)
MAP/
mmHg
SpO2/
%
C组
麻醉诱导前即刻 74.2±10.4 65.4±9.2 98.3±1.2
气管插管前即刻 71.3±11.2 63.3±8.9 100.0±0.0
气管插管后10 min 74.6±9.9 66.2±7.1 100.0±0.0
手术开始即刻 72.5±10.3 64.4±9.0 100.0±0.0
手术结束时 75.3±11.5 62.4±8.8 100.0±0.0
气管拔管前即刻 76.2±10.6 66.0±9.2 100.0±0.0
气管拔管后10 min 72.1±9.7 66.2±7.8 98.1±2.0
E组
麻醉诱导前即刻 72.1±10.3 66.7±8.1 97.2±2.4
气管插管前即刻 70.6±12.6 62.2±7.8 100.0±0.0
气管插管后10 min 73.2±9.8 62.6±9.0 100.0±0.0
手术开始即刻 74.2±11.2 63.1±8.7 100.0±0.0
手术结束时 73.1±10.4 67.2±10.3 100.0±0.0
气管拔管前即刻 75.2±9.4 66.5±9.0 100.0±0.0
气管拔管后10 min 74.6±11.4 67.2±8.8 98.5±1.7
表2  两组患者围手术期 HR、MAP、SpO2比较
组别 手术节段/
手术时间 麻醉时间
min
C组 2.5±0.2 188.2±31.4 225.2±29.6
E组 2.7±0.3 197.4±27.5 216.8±32.1
表3  两组患者手术节段、手术时间、麻醉时间比较
组别 丙泊酚 苯磺顺阿曲库铵 瑞芬太尼/
μg
mg
C组 1 526.2±134.5 2 452.2±232.5 31.8±4.2
E组 1 305.8±212.8*1 2 076.8±311.6*1 22.3±5.1*2
表4  两组患者丙泊酚 、瑞芬太尼、苯磺顺阿曲库铵用药总量比较
组别 4 h 8 h 24 h 48 h
C组 3.1±1.2 2.9±0.7 2.3±1.1 2.4±0.8
E组 1.2±0.9*1 1.7±1.0*1 2.2±0.9 2.5±0.6
表5  两组患者手术后静息时4,8,24,48 h VAS评分比较
组别 例数 恶心 呕吐 腹胀 手术中
知晓
皮肤
瘙痒
尿潴留
C组 29 3 3 1 0 1 2
E组 29 2 3 2 1 0 1
表6  两组患者手术后48 h内并发症发生情况比较
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