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| 超声引导下腹横筋膜平面阻滞用于髂嵴前部取骨移植术的效果 |
| Effect of ultrasound-guided transversealis fascia plane block for anterior iliac crest bone graft harvesting |
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| DOI：10.12089/jca.2023.10.009 |
| 中文关键词: 超声引导 腹横筋膜平面阻滞 髂嵴前部 骨移植 全身麻醉 镇痛 |
| 英文关键词: Ultrasound-guided Transversalis fascia plane block Anterior iliac crest Bone graft harvesting General anesthesia Analgesia |
| 基金项目: |
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| 中文摘要: |
目的 探讨超声引导下腹横筋膜平面(TFP)阻滞在髂嵴前部取骨移植术的应用效果。
方法 选择行髂嵴前部取骨移植术患者59例，男32例，女27例，年龄18～64岁，BMI 18～24 kg/m2，ASA Ⅰ或Ⅱ级。将患者随机分为两组：超声引导下TFP阻滞联合全麻组（T组，n=30）和常规全麻组（G组，n=29）。T组行超声引导下术侧TFP阻滞，G组不进行TFP阻滞。记录麻醉诱导前1 min、手术开始后1、10、30、60 min和手术结束时的HR、MAP和呼出气七氟醚浓度（CETSev）、术中芬太尼、瑞芬太尼和丙泊酚用量、拔管时间、PACU停留时间。记录术后4、8、12、24、48 h髂骨供区的静息和活动时VAS疼痛评分。记录PCIA总按压次数、有效按压次数、曲马多补救镇痛用量、补救镇痛和患者对髂骨供区镇痛的满意情况。
结果 与G组比较，手术开始后1、10、30 min T组HR明显减慢、MAP明显降低（P＜0.05），手术开始后1 min至手术结束时T组CETSev明显降低（P＜0.05）；T组术中芬太尼、瑞芬太尼和丙泊酚用量明显减少（P＜0.05），拔管时间和PACU停留时间明显缩短（P＜0.05）；T组术后4、8、12 h的静息和活动时VAS疼痛评分、术后PCIA总按压次数、有效按压次数、曲马多补救镇痛用量明显减少（P＜0.05）、补救镇痛率明显降低（P＜0.05），患者对髂骨供区镇痛满意率明显升高（P＜0.05）。
结论 超声引导下TFP阻滞用于髂嵴前部取骨移植术麻醉和镇痛效果较好，有利于减少围术期麻醉镇痛药用量，血流动力学平稳，恢复快速，安全性高，患者满意度高。 |
| 英文摘要: |
Objective To investigate the effect of ultrasound-guided transversalis fascia plane (TFP) block in anterior iliac crest bone graft harvesting.
Methods Fifty-nine patients undergoing anterior iliac crest bone graft harvesting were selected, 32 males and 27 females, aged 18-64 years, BMI 18-24 kg/m2, ASA physical status Ⅰ or Ⅱ. Patients were randomly divided into two groups: ultrasound-guided transversalis fascia plane block combined with general anesthesia group (group T, n = 30) and conventional general anesthesia group (group G, n = 29). Patients in group T received ultrasound-guided TFP block, while patients in group G did not receive TFP block. HR, MAP and exhaled concentration of sevoflurane (CETSev) at 1 minute before anesthesia induction, 1 minute, 10, 30, 60 minutes after skin incision, the end of surgery, the duration of the procedure and anaesthesia, the consumption of fentanyl, remifentanil and propofol during the procedure, extubation time, PACU stay time of two groups were recorded. Postoperative pain at iliac bone donor site were assessed using visual analog scale (VAS) pain score at rest and during exercise 4, 8, 12, 24 hours after the surgery. Total compression times, effective compression times of PCIA and the consumption of tramadol, and the rate of remedial analgesia were recorded. Patients' satisfaction with analgesia for iliac bone donor site was accessed.
Results Compared with group G, HR slowed down significantly and MAP decreased significantly at 1 minute, 10, 30 minutes after skin incision in group T(P < 0.05), and CETSev were significantly lower from 1 minute after skin incision to the end of the surgery in group T(P < 0.05), the consumption of fentanyl, remifentanil and propofol during the procedure in group T were significantly reduced(P < 0.05), extubation time and PACU stay time were also significantly shortened(P < 0.05), VAS pain scores at rest and during exercise 4, 8 and 12 hours after the surgery in group T were significantly lower(P < 0.05), the total and effective compression times of PCIA, the consumption of tramadol, and the rate of rescue analgesia in group T were significantly lower(P < 0.05), the rate of patients' satisfaction with analgesia at iliac bone donor site in group T was significantly higher (P < 0.05).
Conclusion Ultrasound-guided TFP block has the potential to provide reliable anesthesia and analgesia for patients undergoing anterior iliac crest bone graft harvesting. It could reduce consumption of anesthetics and analgesics during the perioperative period, stabilize hemodynamics, rapidly promote recovery with a better safety profile and high patients' satisfaction. |
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