[1]范俊 林建水 刘小红 李琪① 颜景佳**.竖脊肌平面阻滞在老年全麻髋部手术中的应用效果[J].中国微创外科杂志,2024,01(3):196-201.
　Fan Jun,Lin Jianshui,Liu Xiaohong,et al.Application Effect of Erector Spinae Plane Block in General Anesthesia Hip Surgery in Elderly Patients[J].Chinese Journal of Minimally Invasive Surgery,2024,01(3):196-201.
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竖脊肌平面阻滞在老年全麻髋部手术中的应用效果()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2024年3期
页码:
196-201
栏目:
临床研究
出版日期:
2024-03-25

文章信息/Info

Title:
Application Effect of Erector Spinae Plane Block in General Anesthesia Hip Surgery in Elderly Patients
作者:
范俊 林建水 刘小红 李琪① 颜景佳**
(晋江市医院上海市第六人民医院福建医院麻醉科，泉州362200)
Author(s):
Fan Jun;  Lin Jianshui;  Liu Xiaohong;  et al.
Department of Anesthesiology, Jinjiang Municipal Hospital, Shanghai Sixth People’s Hospital Fujian Campus, Quanzhou 362200, China
关键词:
竖脊肌平面阻滞; 髋部手术; 老年患者; 镇痛效果; 苏醒质量
Keywords:
Erector spinae plane block; Hip surgery; Elderly patient; Analgesic effect; Recovery quality
文献标志码:
A
摘要:
目的探讨老年人全麻髋部手术前行L4横突竖脊肌平面阻滞(erector spinae plane block，ESPB)减轻围术期疼痛和应激从而减少阿片类药用量和提高术后苏醒质量的效果。方法选择2023年1~12月65岁及以上单侧髋关节手术60例，按随机数字表法分为2组(n=30)，阻滞组诱导前在超声引导下于L4横突水平行ESPB(局麻药为0.3%罗哌卡因0.5 ml/kg)，对照组未行ESPB。2组均采用喉罩全麻，诱导、麻醉维持方法一致。使用数字评价量表(Numerical Rating Scale，NRS)评价术后8、24 h疼痛程度，记录术后24 h内镇痛泵按压次数；观察2组术中各时点血流动力学变化；记录手术结束至患者完全苏醒时间、拔除喉罩时间；记录术中和麻醉后恢复室(Postanesthesia Care Unit，PACU)的阿片类药物使用量；记录术后躁动、恶心呕吐、头晕发生率及苏醒质量评分。结果术后8、24 h静息及运动疼痛NRS评分阻滞组均明显低于对照组，24 h镇痛泵按压次数阻滞组明显少于对照组(P<0.05)。切皮后20 min阻滞组平均动脉压低于对照组［(87.2±15.5)mm Hg vs. (967±16.9)mm Hg，P=0.026］。阻滞组舒芬太尼用量、瑞芬太尼用量、使用乌拉地尔例数均明显少于对照组［12.5(10.0,14.0)μg vs. 12.5(12.5,17.5)μg，P=0.041；270(100,400)μg vs.600(448,800)μg，P<0.001；1例vs. 11例，P=0.001］。入麻醉后恢复室30 min的Steward苏醒评分阻滞组明显高于对照组［6(5,6)分 vs.5(4,5)分，P<0.001］。术后躁动、恶心呕吐、头晕2组比较无统计学意义(P>0.05)。结论术前L4横突水平行ESPB可降低术后24 h内疼痛评分，减少老年髋部手术术中、术后阿片类药用量，提高术后苏醒质量。
Abstract:
ObjectiveTo investigate the effect of L4 transverse process erector spinae plane block (ESPB) before general anesthesia hip surgery in elderly patients on reducing perioperative pain and stress, thus reducing opioid consumption and improving postoperative recovery quality.MethodsSixty patients aged 65 years old and above who underwent unilateral hip surgery from January to December 2023 were randomly divided into two groups (n=30) by using the random number table method. The ESPB group received ultrasoundguided ESPB at the L4 level with 0.3% ropivacaine （0.5 ml/kg） before induction of anesthesia, while the control group did not receive ESPB. Laryngeal mask anesthesia was administered in both groups. The induction and maintenance methods were consistent in both groups. The Numerical Rating Scale (NRS) was used to evaluate the degree of pain at 8 h and 24 h after surgery. The times of pressing analgesic pump within 24 h after surgery were recorded. The hemodynamic changes at each time point during the operation were observed. The time interval from the end of the operation to the complete recovery and to remove the laryngeal mask were recorded. Intraoperative and Postanesthesia Care Unit (PACU) opioid consumption were noted. The incidence of postoperative agitation, postoperative nausea and vomiting (PONV), dizziness, and the recovery quality score were compared. ResultsThe NRS scores of rest pain and motion pain at 8 h and 24 h after surgery were significantly lower in the ESPB group than those in the control group, and the times of pressing the analgesic pump within 24 h after surgery in the ESPB group was significantly less than that in the control group (P<0.05). The mean arterial pressure (MAP) of the ESPB group at 20 min after peeling was lower than that of the control group ［(87.2±15.5) mm Hg vs. (96.7±16.9) mm Hg, P=0.026］. The sufentanil consumption, remifentanil consumption, and the number of cases using urapidil in the ESPB group were significantly lower than those in the control group［12.5 (10.0, 14.0) μg vs. 12.5 (12.5, 17.5) μg, P=0.041; 270 (100, 400) μg vs. 600 (448, 800) μg, P<0.001; 1 case vs. 11 cases, P=0.001］. The Steward score at 30 min after entering PACU was significantly higher in the ESPB group than in the control group ［6(5, 6) points vs. 5(4, 5) points, P<0.001］. There was no statistical significance in incidence of postoperative agitation, PONV, and dizziness between the two groups (P>0.05).ConclusionPreoperative ESPB at the level of the L4 transverse process can reduce the pain score within 24 h after surgery, reduce the amount of opioid used during and after hip surgery, and improve the quality of postoperative recovery in the elderly.

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备注/Memo

备注/Memo:
基金项目：晋江市医院(上海市第六人民医院福建医院)2022年度院级科技计划项目(2022LC05)**通讯作者，Email：245118265@qq.com ①（上海交通大学医学院附属第六人民医院麻醉科，上海200233)
更新日期/Last Update: 2024-06-03