【摘要】 目的观察超声引导肋缘下腹横平面联合腹直肌鞘神经阻滞在胃癌根治术麻醉中的应用效果。方法选择择期腔镜胃癌根治术患者30例,男19例,女11例,年龄38～88岁,ASAⅠ～Ⅲ级,随机分成实验组(T组)和对照组(C组)各15例。全麻后T组在超声引导下用0.33%罗哌卡因行区域阻滞,每侧肋缘下腹横平面2针6点法联合腹直肌鞘1针2点法注射,双侧容量共60mL;C组全麻不阻滞。记录患者腹壁穿刺前后1、3、5、10min的心率(HR)和平均动脉压(MAP),术中阿片类药物的用量,术后静息视觉模拟评分(VAS),以及有无不良反应。结果 T组穿刺前后1min的HR和MAP无明显变化(均P>0.05);C组穿刺前后1min的HR和MAP变化差异有统计学意义(均P<0.01);T组术中瑞芬太尼用量明显少于C组(P<0.01);T组患者各时间段术后VAS评分均较C组低(均P<0.05);术后镇痛泵按压次数T组少于C组(P<0.05)。结论全麻下腹横平面联合腹直肌鞘神经阻滞用于胃癌根治术,术中、术后镇痛效果良好。更多还原

【Abstract】 Objective To evaluate the analgesic efficacy of oblique subcostal transversus abdominis plane block(OSTAPB)in combination with rectus sheath block through ultrasound guidance for radical surgery of gastric cancer. Methods Thirty patients with gastric cancer scheduled for radical gastrectomy were randomly assigned into groups T and C,with fifteen patients in each group.There were 19 males and 11 females,aged from 38-88 and with ASA ⅠtoⅢ.After general anesthesia,patients in group T received ultrasound-guided regional anesthesia,during which 0.33% ropivacaine hydrochloride was injected at 6 points in each side of abdomen and 2 points in rectus abdominal sheath.Total injection volume was 60 mL for both sides.Patients in group C were only treated by general anesthesia.The heart rate(HR)and mean arterial pressure(MAP)were recorded before and after the abdominal wall was punctured at 1,3,5,10 min.The dosage of opioids and related surgical complications were closely monitored during the surgery.Visual analogue scale(VAS)scores were recorded and adverse side effects were observed after the surgery.Results In group T,both HR and MAP showed no apparent changes before and 1 min after abdominal puncture(P>0.05).But in group C,both HR and MAP were significantly increased 1 min after the abdominal wall was punctured(P<0.01).The use of remifentanil during the surgery and the analgetic pump after surgery was less in group T than that in group C(P<0.05).The VAS scores were significantly reduced in group T when compared with those in group C at all tested postoperative time points(P<0.05).Conclusion The modified ultrasound-guided bilateral OSTAPB in combination with rectus sheath block has good operative and post-operative analgesia in the radical surgery for gastric cancer.更多还原