竖脊肌平面阻滞与硬膜外镇痛对腹腔镜胃大部切除患者术后疼痛状况的影响

Comparison of Analgesic Effect between Bilateral Ultrasound-Guided Erector Spinae Plane Block and Epidural Block Techniques for Postoperative Analgesia in Patient Undergoing Laparoscopic Subtotal Gastrectomy

摘要: 目的：对比双侧竖脊肌平面阻滞(erector spinae plane block, ESPB)与硬膜外镇痛对腹腔镜胃大部切除患者术后疼痛状况的影响｡方法：40例择期接受腹腔镜胃大部切除手术的患者，随机分为ESPB组(A组)和硬膜外镇痛组(B组)，每组20例。A组于麻醉诱导前行双侧ESPB，术毕给予病人自控静脉镇痛(patient controlled intravenous analgesia, PCIA)；B组于麻醉诱导前行硬膜外穿刺并置管，术毕给予病人自控硬膜外镇痛(patient controlled epidural analgesia, PCEA)。比较两组患者术后视觉模拟评分法(VAS)评分情况、术后不良反应发生率及对术后镇痛的满意度评分。结果：A组患者术后2、6、8、12、24 h VAS评分均高于B组，差异无统计学意义(P > 0.05)。A组低血压发生率、尿潴留发生率低于B组(P < 0.05)；两组恶心、皮肤瘙痒发生率无统计学差异(P > 0.05)。A组患者对术后镇痛满意度评分高于B组(P > 0.05)。结论：与硬膜外镇痛相比，双侧ESPB联合PCIA用于腹腔镜胃大部切除术能取得相似的术后镇痛效果，且不良反应发生率低，患者满意度高。

Abstract: Objective: To compare the effects of bilateral ultrasound-guided erector spinae plane block (ESPB) and epidural block techniques on postoperative analgesia in patients undergoing laparoscopic subtotal gastrectomy. Methods: 40 patients undergoing elective laparoscopic subtotal gastrectomy were divided into two groups stochastically, the bilateral ESPB group (group A) and the PECA group (group B), 20 cases in each group. The patients in group A were given a bilateral ESPB before induction of general anesthesia and received PCIA after surgery. The patients in group B were given epidural block before induction of general anesthesia and received PCEA after surgery. Scores of visual analog scale (VAS) were compared between the two groups. The side-effects and patient’s satisfaction with postoperative analgesia were recorded as well. Results: The VAS scores in group A were higher than those in group B at 2 h after surgery, at 6 h after surgery, at 8 h after surgery, at 12 h after surgery, at 24 h after surgery (P > 0.05). The incidence of hypotension and urinary retention in group A was lower than that of group B (P < 0.05). There was no statistical difference in the incidence of nausea and skin itch between the 2 groups (P > 0.05). The satisfaction score of group A was higher than that of group B (P > 0.05). Conclusion: Bilateral ESPB combined with PCIA for postoperative analgesia after laparoscopic subtotal gastrectomy can achieve the same effect as epidural analgesia, the incidence of adverse reactions is lower, and patient satisfaction is high.