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| 超声引导下腰方肌阻滞在腹膜透析置管术中的应用效果 |
| Effect of ultrasound-guided quadratus lumborum block for peritoneal dialysis catheter placement |
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| DOI：10.12089/jca.2019.10.006 |
| 中文关键词: 超声引导 腰方肌阻滞 腹膜透析置管术 腹横肌平面阻滞 |
| 英文关键词: Ultrasound-guided Quadratus lumborum block Peritoneal dialysis catheter placement Transversus abdominis plane block |
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| 中文摘要: |
目的 观察超声引导下腰方肌阻滞在腹膜透析置管术中应用的有效性及安全性。
方法 选择择期行腹膜透析置管术终末期肾病患者90例,男49例,女41例,年龄45～65岁,ASA Ⅲ或Ⅳ级,随机分为三组,每组30例:A组采用局麻,B组采用0.5％罗哌卡因25 ml行超声引导下腹横肌平面阻滞,C组采用0.5％罗哌卡因25 ml行超声引导下腰方肌阻滞。记录麻醉前(T0)、阻滞完成后30 min(T1)、切皮时(T2)、置管时(T3)、打隧道穿刺出皮肤时(T4)和缝合切口时(T5)的MAP和HR;记录舒芬太尼追加例数,记录T2—T5时VAS评分和围术期不良反应的发生情况。
结果 T3—T4时C组MAP明显低于A组和B组,HR明显慢于A组和B组(P＜0.05),B组MAP明显低于A组,HR明显慢于A组(P＜0.05)。T3—T4时C组VAS评分明显低于A组和B组(P＜0.05),B组VAS评分明显低于A组(P＜0.05)。C组舒芬太尼追加例数明显少于A组和B组(P＜0.05)，A组舒芬太尼追加例数明显多于B组(P＜0.05)。三组下肢乏力发生率差异无统计学意义,三组均无一例其他不良反应。三组围术期均未发生明显的穿刺并发症。
结论 超声引导下腰方肌阻滞麻醉应用于终末期肾病患者腹膜透析置管术中效果确切,可减少麻醉性镇痛药的使用,不增加不良反应。 |
| 英文摘要: |
Ojective To observe the validity and safety of ultrasound-guided quadratus lumborum block for peritoneal dialysis catheter placement.
Methods Ninety uremic patients with end-stage renal disease undergoing peritoneal dialysis catheterization, 49 males and 41 females, aged 45-65 years, falling into ASA physical status Ⅲ or Ⅳ, were enrolled in this study and divided into 3 groups: group A underwent local anesthesia, group B underwent 0.5 ml ropivacaine abdominal transverse plane block under ultrasound-guide and group C underwent 0.5％ ropivacainelumbar muscle block under ultrasound-guide. The mean artery pressure (MAP) and heart rate (HR) were recorded before anesthesia (T0), 30 min after completion of the block (T1), when the skin was cut (T2), when the tube was placed (T3), when the tunnel was pierced (T4) and the suturing incision (T5). The cases received sufentanil was recorded. The visual analogue score (VAS) at T2-T5 in three groups was recorded. The incidence of adverse reactions during perioperative period were recorded.
Results The MAP and HR in group C were lower than those in group A and group B, and the MAP and HR in group B were lower than those in group A at T3-T4(P ＜ 0.05). The VAS scores in group C was lower than those in group A and group B, and the VAS scores in group B were lower than those in group A at T3-T4(P ＜ 0.05). Compared with group C, the cases received sufentanil in group A and group B were increased(P ＜ 0.05). The cases received sufentanil were decreased in group B compared with group A(P ＜ 0.05). There was no significant difference in the incidence of lower limb weakness between the three groups. There were no obvious other puncture complications in the three groups during anesthesia.
Conclusion Ultrasound-guide quadratus lumborum block for peritoneal dialysis catheter placement is effective, reduces the total consumption amount of intravenous analgesics during operation without more adverse reactions. |
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