超声引导腹壁神经阻滞联合右美托咪定在腹膜透析置管术中的应用

江仁 张意珍 李 平 李双月 李红 杨伟东 和伟易

[摘要] 目的 探讨超声引导腹壁神经阻滞联合右美托咪定在腹膜透析置管术中的安全性与有效性。 方法 选取2018年5月至2019年3月我院终末期肾脏病择期行腹膜透析置管术患者60例，ASA Ⅲ～Ⅳ，年龄19～69岁，体重45～80 kg，随机分为三组（n=20）：局部浸润阻滞组（L组）、超声引导腹横肌平面阻滞联合腹直肌鞘阻滞组（TR组）、超声引导腹壁神经阻滞联合右美托咪定组（TRD组）。观察三组患者入室（T1）、切皮（T2）、分离（T3）、探查（T4）、置管（T5）、缝皮（T6）和出室（T7）各时点平均动脉压（MAP）、心率（HR）和视觉模拟疼痛评分（VAS）、手术时间、术后24 h静息/运动VAS评分、患者满意度、医生满意度及麻醉相关并发症。 结果 与L组比较，TR组患者T3～T5时点MAP明显降低（P<0.05），T2～T7时点HR明顯下降（P<0.05），T3～T6时点VAS评分明显下降（P<0.05），手术时间明显缩短（t=3.680，P=0.001），术后2 h、6 h、12 h和24 h静息/运动VAS评分均明显降低（P<0.05），患者满意度和医生满意度明显升高（Z=3.351，P=0.001;Z=5.213，P<0.05）;与L组比较，TRD组患者T2～T7 时点MAP和HR明显降低（P<0.05），手术时间明显缩短（t=3.250，P=0.002），T2～T6 VAS评分均明显降低（P<0.05），患者满意度和医生满意度明显升高（Z=4.528，P<0.05;Z=5.213，P<0.05）;与TR组比较，TRD组患者T2 VAS评分明显降低（Z=2.670，P=0.007），T4～T7时点MAP明显下降（t=2.100，P=0.043;t=2.270，P=0.029;t=2.540，P=0.015;t=2.110，P=0.041），T6和T7时点HR明显下降（t=2.450，P=0.019;t=2.150，P=0.038），患者满意度明显升高（Z=2.047，P=0.041）;三组患者均未发生麻醉相关并发症。结论 超声引导腹壁神经阻滞联合右美托咪定用于腹膜透析置管术安全且麻醉镇痛更完善，术中血流动力学波动小，术后镇痛效果较好，患者满意度高，是腹膜透析置管术更为理想的麻醉选择。

[关键词] 超声引导;腹横肌平面阻滞;腹直肌鞘阻滞;腹膜透析置管术;右美托咪定

[中图分类号] R692.5          [文献标识码] B          [文章编号] 1673-9701（2021）25-0121-05

Application of ultrasound-guided abdominal wall nerve block combined with dexmedetomidine in peritoneal dialysis catheterization

JIANG Ren1   ZHANG Yizhen2   LI Ping1   LI Shuangyue1   LI Hong1   YANG Weidong1   HE Weiyi1

1.Department of Anesthesiology， Ningbo Yinzhou No.2 Hospital， Ningbo   315100， China; 2.Department of Ultrasound， Ningbo Yinzhou No.2 Hospital， Ningbo   315100， China

[Abstract] Objective To investigate the safety and effectiveness of ultrasound-guided abdominal wall nerve block combined with dexmedetomidine in peritoneal dialysis catheterization. Methods A total of 60 end-stage renal disease patients with ASA Ⅲ-Ⅳ， 19-69 years old， 45-80 kg who underwent selective peritoneal dialysis in our hospital from May 2018 to March 2019 were randomly divided into three groups （n=20）：local infiltration block group （L group）， ultrasound guided transverse abdominal muscle plane block combined with rectus sheath block （TR group）， ultrasound guided abdominal wall nerve block combined with dexmedetomidine group （TRD group）. The mean arterial pressure （MAP）， heart rate （HR）and visual analog pain score （VAS）， operation time， 24 h rest/exercise VAS score after surgery， patient satisfaction， doctor satisfaction， and anesthesia-related complications when When entering the room （T1）， cutting the skin （T2）， separating （T3）， exploring （T4）， placing the tube （T5）， suturing the skin （T6） and leaving the room （T7） of the three groups were observed. Results Compared with that of the L group， the MAP of patients in the TR group was significantly lower at T3-T5 （P<0.05）; the HR decreased substantially at T2-T7 （P<0.05）; the VAS score at T3-T6 decreased significantly （P<0.05）; the operation time was significantly shortened （t=3.680， P=0.001）; the rest/exercise VAS scores of 2 h， 6 h， 12 h and 24 h after operation were significantly reduced （P<0.05）; the patient satisfaction and doctor satisfaction were increased considerably （Z=3.351， P=0.001; Z=5.213， P<0.05）. Compared with that of the L group， the MAP and HR of patients in the TRD group at T2-T7 was significantly lower （P<0.05）， and the operation time was shortened obviously （t=3.250， P=0.002）， the intraoperative VAS score was significantly reduced at T2-T6 （P<0.05）， and patient satisfaction and doctor satisfaction was increased considerably （Z=4.528， P<0.05; Z=5.213， P<0.05）. Compared with that of the TR group， the T2 VAS score of the TRD group was significantly reduced （Z=2.670， P=0.007）; the MAP at T4-T7 was significantly decreased （t=2.100， P=0.043; t=2.270， P=0.029; t=2.540， P=0.015; t=2.110， P=0.041）; the HR at T6-T7 decreased significantly （t=2.450， P=0.019; t=2.150， P=0.038）; patient satisfaction at T6-T7 was significantly increased （Z=2.047， P=0.041）. No anesthesia-related complications occurred in the three groups. Conclusion Ultrasound-guided abdominal wall nerve block combined with dexmedetomidine is safe and more perfect for peritoneal dialysis catheterization， with small fluctuations of hemodynamics， better postoperative analgesia， and high patient satisfaction. It is an ideal anesthesia choice for peritoneal dialysis catheterization.