文章摘要
不同浓度罗哌卡因竖脊肌平面阻滞在腹腔镜下胃癌根治术中的应用效果
Analgesic effect of ultasound-guided erector spinae plane block with different concentrations of ropivacaine on patients undergoing laparoscopic gastric cancer surgery
  
DOI：10.12089/jca.2020.10.014
中文关键词: 罗哌卡因  竖脊肌平面阻滞  腹腔镜  胃癌根治术  炎性因子
英文关键词: Ropivacaine  Erector spinae plane block  Laparoscopy  Radical gastric cancer surgery  Inflammatory factors
基金项目:国家自然科学基金（81971872）
作者单位E-mail
胡海青 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
鲍红光 210006,南京医科大学附属南京医院,南京市第一医院麻醉科 hongguang_bao@163.com 
单涛 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
朱美华 南京中医药大学第二附属医院麻醉科  
牛聪 南京中医药大学第二附属医院麻醉科  
杜佳月 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
徐漫 210006,南京医科大学附属南京医院,南京市第一医院麻醉科  
吴丹 南京中医药大学第二附属医院麻醉科  
陈志勇 南京中医药大学第二附属医院麻醉科  
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中文摘要:
      
目的 观察不同浓度罗哌卡因竖脊肌平面阻滞（ESPB）对腹腔镜下胃癌根治术患者术中镇痛效果和炎性因子的影响。
方法 择期行腹腔镜胃癌根治术患者80例，男54例，女26例，年龄40～65岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法将患者分为四组，每组20例。S1、S2、S3组行双侧ESPB，每侧分别注射0.25%、0.375%、0.5%罗哌卡因，随后行全身麻醉；C组行单纯全身麻醉。术中采用全凭静脉麻醉，术毕行舒芬太尼PCIA。记录阻滞起效时间和持续时间；记录术后2、8、12、24、48 h静息和运动时VAS疼痛评分；记录术中舒芬太尼用量、术后48 h内镇痛泵有效按压次数和舒芬太尼追加情况。记录术后2、8、12、24 h血清IL-6和IL-10浓度；记录术后呼吸抑制、恶心呕吐、局麻药中毒等不良反应情况。
结果 与S1组比较，S2组、S3组阻滞起效时间明显缩短（P<0.05）；与S2组比较，S3组阻滞起效时间明显缩短（P<0.05）。三组阻滞持续时间差异无统计学意义。与C组比较，S1组、S2组、S3组术后2、8、12 h静息和运动时VAS疼痛评分明显降低（P<0.05）；与S1组比较，S2组、S3组术后8 h静息和运动时VAS疼痛评分明显降低（P<0.05）。与C组比较，S1组、S2组、S3组术中舒芬太尼用量和术后48 h内镇痛泵有效按压次数明显减少（P<0.05）。与S1组比较，S2组、S3组术后48 h内镇痛泵按压次数明显减少（P<0.05）。与C组比较，S2、S3组术后追加舒芬太尼例数明显减少（P<0.05）。与C组比较，术后8、12 h S1组、S2组、S3组IL-6浓度明显降低，IL-10浓度明显升高（P<0.05）。四组术后呼吸抑制、恶心呕吐发生率差异无统计学意义。S3组术后有1例（5%）出现肌肉震颤的局麻药中毒反应。
结论 超声引导下0.375%罗哌卡因ESPB可减少腹腔镜下胃癌根治术的围术期阿片类药物用量，镇痛效果确切，同时减轻胃癌患者术后炎症反应。
英文摘要:
      
Ojective To observe the efficacy of ropivacaine at different concentrations on analgesia and inflammatory factors in patients undergoing laparoscopic gastric cancer surgery under erector spinae plane block.
Methods Eighty patients with laparoscopic radical gastrectomy for gastric cancer, 54 males and 26 females, aged 45-65 years, with a BMI 18-25 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were divided into four groups (n = 30) by random number table. Group S1, S2 and S3 was respectively given bilateral injection of 0.25%, 0.375% and 0.5% ropivacaine for erector spinae plane block, followed by general anesthesia. Group C received general anesthesia only. During the operation, total intravenous anesthesia was used, and patient-controlled intravenous analgesia with sufentanil was performed after the operation. The onset time and duration of block were recorded. VAS pain score was recorded 2, 8, 12, 24, 48 h after operation. The dosage of sufentanil during operation, the total number of effective pressing of analgesic pump with 48 h after operation and the additional dosage of sufentanil were recorded. The serum levels of IL-6 and IL-10 were recorded 2, 8, 12, and 24 h after surgery. Adverse reactions such as respiratory depression, nausea and vomiting, and local anesthetic poisoning were recorded.
Results Compared with group S1, the onset time of block in groups S2 and S3 was significantly shorter (P < 0.05). The onset time in group S3 was significantly shorter than that in group S2 (P < 0.05). There was no significantly difference in the duration of block among the three groups. Compared with group C, the VAS pain scores in groups S1, S2 and S3 were significantly lower 2, 8, and 12 h after operation (P < 0.05). Compared with group C, the intraoperative sufentanil dosage and the number of analgesic pump compressions in groups S1, S2 and S3 decreased significantly (P < 0.05). Compared with group S1, the number of compressions of the analgesic pump was significantly reduced in groups S2 and S3 (P < 0.05). Compared with group C, the number of sufentanil supplements in groups S2 and S3 was significantly reduced after surgery (P < 0.05). The serum levels of IL-6 and IL-10 were recorded 2, 8, 12, and 24 h after surgery. Adverse reactions such as respiratory depression, nausea and vomiting, and local anesthetic poisoning were recorded.
Conclusion ultrasound-guided spinae plane block in 0.375% ropivacaine reduces the amount of opioids used in perioperative period of laparoscopy gastric cancer radical operation, but also has definite analgesic effect, and reduces the inflammatory reaction after operation in patients with gastric cancer．
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