内科理论与实践

内科理论与实践 ›› 2023, Vol. 18 ›› Issue (03): 152-156.doi: 10.16138/j.1673-6087.2023.03.004

• 论著 • 上一篇    下一篇

超声引导下腹横肌平面联合腹直肌鞘神经阻滞在腹膜透析置管术中的应用研究

王朝俊1*, 俞灵1*, 王恒杰1, 任红2, 史曼曼1, 郑洪1, 马毓华1(), 徐天2()   

  1. 1.南京中医药大学昆山附属医院肾病科，江苏 昆山 215300
    2.上海交通大学医学院附属瑞金医院肾脏内科，上海 200025
  • 收稿日期:2022-10-31 出版日期:2023-06-30 发布日期:2023-08-07
  • 通讯作者: 马毓华 E-mail: jigsaw@yeah.net；徐 天 E-mail: minson_xu@126.com
  • 作者简介:*王朝俊与俞灵为共同第一作者
  • 基金资助:
    南京中医药大学自然科学基金(XZR 2020065);苏州市科技发展计划(SYSD2019028)

Contrast study on efficacy of ultrasound-guided transversus abdominis plane block combined with rectus sheath block in peritoneal dialysis catheterization

WANG Chaojun1*, YU Ling1*, WANG Hengjie1, REN Hong2, SHI Manman1, ZHENG Hong1, MA Yuhua1(), XU Tian2()   

  1. 1. Department of Nephrology, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan 215300, China
    2. Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2022-10-31 Online:2023-06-30 Published:2023-08-07

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摘要：

目的: 对比超声引导下腹横肌平面阻滞（transversus abdominis plane block，TAPB）联合腹直肌鞘神经阻滞（rectus sheath block，RSB）、TAPB以及局部浸润麻醉3种不同麻醉方式在腹膜透析置管术中的效果，探讨并推广腹膜透析置管术理想的麻醉方式。方法: 选择我院2016年5月至2021年6月期间46例行腹膜透析置管术的患者，按随机数字表法分为TAPB联合RSB组（A组）、单纯TAPB组（B组）和局部浸润麻醉组（C组）3组，分析比较3组患者手术过程中不同时间点[麻醉实施时（T0）、切皮时（T1）、分离腹直肌时（T2）、建立皮下隧道时（T3）、缝皮时（T4）]的平均动脉压（mean arterial pressure，MAP）、心率、视觉模拟评分法（visual analogue scale，VAS）评分，及手术时间、麻醉药追加例数、术中和术后不良反应、术后并发症等指标。结果: A组、B组手术全程（包括T0、T1、T2、T3、T4）MAP、心率差异均无统计学意义（均P>0.05），C组不同时间点的MAP、心率间差异有统计学意义（均P<0.05）；与A组相比，B组和C组术中麻醉药追加例数明显增多（均P<0.05）；与A组相比，B组在T2时的VAS评分更高（P<0.05），而C组在T1、T2、T3、T4时的VAS评分更高（P<0.05）；A组手术时间最短，与B组、C组相比差异有统计学意义（P<0.05）。A组术后并发症较B组、C组明显减少（P<0.05）。结论: 在腹膜透析置管手术中，超声引导下TAPB联合RSB与单纯TAPB及局部浸润麻醉相比，麻醉方式安全，患者血流动力学稳定，舒适度好，术后并发症少，是相对理想的麻醉方式。

关键词: 超声引导, 腹横肌平面联合腹直肌鞘神经阻滞, 腹横肌平面神经阻滞, 局部浸润麻醉, 腹膜透析置管术

Abstract:

Objective To compare the effects of ultrasound-guided transversus abdominis plane block(TAPB) combined with rectus sheath block(RSB), TAPB and local infiltration anesthesia in peritoneal dialysis catheterization，and to explore and promote the ideal anesthesia method for peritoneal dialysis catheterization. Methods A total of 46 patients who underwent peritoneal dialysis catheterization in our hospital from May 2016 to June 2021 were enrolled and randomly divided into three groups according to the random number method: ultrasound-guided TAPB combined with RSB (group A)，ultrasound-guided TAPB (group B) and local infiltration anesthesia group (group C). The mean arterial pressure (MAP), heart rate, visual analogue scale (VAS) score at different time points during the operation [anesthesia (T0), skin incision (T1), separation of rectus abdominis (T2), establishment of subcutaneous tunnel (T3), and skin suture (T4)], overall operation duration, number of additional anesthetics, number of intraoperative and postoperative adverse reactions and postoperative complications were compared and analyzed among three groups. Results There was no statistically significant difference in MAP and heart rate (all P>0.05) in group A and group B, while both MAP and heart rate in group C showed significant difference (P<0.05) during the operation time (T0, T1, T2, T3 and T4). Compared with group A, additional anesthetics during operation in group B and group C was more frequently used (P<0.05). Compared with group A, the VAS scores of group B at T2, and the VAS scores of group C at T1, T2, T3 and T4 were significantly higher (P<0.05). The operation time of group A was significantly shorter than that of group B and group C (P<0.05). The postoperative complications in group A were significantly less than those in group B and group C (P<0.05). Conclusions Compared with ultrasound-guided TAPB and local infiltration anesthesia, the ultrasound-guided TAPB combined with RSB is a relatively ideal anesthesia method for peritoneal dialysis catheterization, which shows the advantages of safe anesthesia, stable hemodynamics, better comfort and fewer postoperative complications.

Key words: Ultrasound-guided, Transversus abdominis plane block combined with rectus sheath block, Transversus abdominis plane block, Local infiltration anesthesia, Peritoneal dialysis catheterization

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