竖脊肌平面阻滞联合星状神经节阻滞在老年腹腔镜全子宫切除术中的应用效果

doi:10.3969/j.issn.1003-9198.2025.01.012

摘要/Abstract

摘要： 目的探究竖脊肌平面阻滞(ESPB)联合星状神经节阻滞(SGB)在老年腹腔镜全子宫切除术(LTH)中的应用效果。方法选取连云港市妇幼保健院2021—2023年收治的116例行LTH的老年病人,采用随机数表法分成2组,每组58例。在麻醉诱导前,对照组予以ESPB,联合组予以ESPB联合SGB。比较2组手术指标、麻醉药物用量、VAS评分、补救镇痛情况、术后恢复、应激指标、不良反应情况及麻醉诱导前(T0)、麻醉后5 min(T1)、术毕(T2)时刻的心率(HR)和平均动脉压(MAP)。结果 2组手术时间、术中出血量、术后首次下床时间、住院时间及不良反应发生率差异均无统计学意义(P＞0.05);联合组丙泊酚、舒芬太尼用量及镇痛泵按压次数、补救镇痛率、术后首次排气时间均低于对照组(P＜0.05)。术后6、12、24 h,2组VAS评分均逐渐下降,且联合组低于对照组(P＜0.05)。2组T1、T2时刻MAP、HR水平均较T0时刻升高,T2时刻较T1时刻下降,但联合组T1、T2时刻MAP、HR水平均低于对照组(P＜0.05)。术后2组皮质醇(Cor)、P物质(SP)水平均高于术前,但联合组低于对照组(P＜0.05)。结论行LTH的老年病人应用ESPB联合SGB可有效提升镇痛效果,减少镇痛药物用量,维持血流动力学稳定,减轻应激反应,且安全可靠。

关键词: 竖脊肌平面阻滞, 星状神经节阻滞, 腹腔镜全子宫切除术, 老年人, 镇痛效果

Abstract: Objective To investigate the effects of erector spinae plane block (ESPB) combined with stellate ganglion block (SGB) in the elderly patients undergoing laparoscopic total hysterectomy (LTH). Methods A total of 116 elderly patients who underwent LTH in Lianyungang Maternal and Child Health Hospital from January 2021 to December 2023 were selected and divided into two groups by random number table method, with 58 cases in each group. The patients in the control group were narcotized by ESPB, and those in the combined group were narcotized by ESPB combined with SGB. The operation indicators, anesthetic drug dosage, VAS score, rescue analgesia, postoperative recovery, stress indicators, adverse reactions, heart rate (HR) and mean arterial pressure (MAP) before anesthesia induction (T0), 5 min after anesthesia (T1) and at the end of operation (T2) were compared between the two groups. Results There were no significant differences in operation time, intraoperative bleeding, time to get out of bed, hospital stay and incidence of adverse reactions between the two groups (P>0.05). The consumption of propofol and sufentanil, pressing times of analgesic pump, rescue analgesia rate and the first postoperative exhaust time in the combined group were lower than those in the control group (P<0.05). At the time of 6, 12 and 24 hours after operation, the VAS score in the two groups gradually decreased, especially in the combined group (P<0.05). The levels of MAP and HR were significantly increased at T1,and then significantly decreased at T2 in the two groups, but the levels of MAP and HR at T1 and T2 in the combined group were lower than those in the control group (P<0.05). After operation, the levels of cortisol (Cor) and substance P (SP) were higher than those before operation in the two groups, especially in the control group (P<0.05). Conclusions ESPB combined with SGB can effectively improve the analgesic effect, reduce the dosage of analgesic drugs, maintain hemodynamic stability, reduce stress response, and is safe and reliable in the elderly patients undergoing LTH.

Key words: erector spinae plane block, stellate ganglion block, laparoscopic total hysterectomy, aged, analgesic effect

中图分类号:

R 614

周晶, 孙洛阳, 王玲, 马加旭. 竖脊肌平面阻滞联合星状神经节阻滞在老年腹腔镜全子宫切除术中的应用效果[J]. 实用老年医学, 2025, 39(1): 51-55.

ZHOU Jing, SUN Luoyang, WANG Ling, MA Jiaxu. Effects of erector spinae plane block combined with stellate ganglion block in elderly patients undergoing total laparoscopic hysterectomy[J]. Practical Geriatrics, 2025, 39(1): 51-55.

参考文献

[1] 陈吉鹏,侯景丽. 超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜子宫切除术中的应用效果[J]. 检验医学与临床,2022,19(8):1022-1025.
[2] HIBINO Y, OKAZAWA-SAKAI M, YOKOYAMA T, et al. Abnormal vaginal cytology after total laparoscopic hysterectomy in patients with cervical intraepithelial neoplasia[J]. Acta Med Okayama, 2023, 77(6):627-634.
[3] 廉海光,李建,吴红发,等. 脊椎硬膜外麻醉联合静吸复合全身麻醉在老年腹腔镜下全子宫切除术中的应用观察[J]. 老年医学与保健,2020,26(6):980-983.
[4] 朱炜,周瑜,杨许丽,等. 老年病人超声引导下肋锁径路神经阻滞与腋路臂丛神经阻滞的效果及安全性比较[J]. 实用老年医学,2021,35(10):1040-1044.
[5] 韦友琴,张智勇,唐强强. 超声引导下不同浓度罗哌卡因竖脊肌平面阻滞联合全身麻醉对腹腔镜全子宫切除术患者的麻醉效果和疼痛阈值的影响[J]. 临床和实验医学杂志,2023,22(3):329-334.
[6] 葛晓燕,王峰,王朋,等. 星状神经节阻滞对腹腔镜全子宫切除术患者术后睡眠质量和恶心呕吐的影响[J]. 临床麻醉学杂志,2023,39(3):241-245.
[7] GERVAIS H W. The ASA Classification - solid like a rock in anesthesiology[J]. Anaesthesist, 2017, 66(1):3-4.
[8] 孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.
[9] FRASSANITO L, ZANFINI B A, CATARCI S, et al. Erector spinae plane block for postoperative analgesia after total laparoscopic hysterectomy: case series and review of the literature[J]. Eur Rev Med Pharmacol Sci, 2020, 24(7):3892-3897.
[10] TANABE S, YAMAMOTO R, SUGINO S, et al. Comparison of postoperative analgesia use between robotic and laparoscopic total hysterectomy: a retrospective cohort study[J]. J Robot Surg, 2023, 17(4):1669-1674.
[11] 程冰,包义勇,肖勇,等. 腹腔镜全子宫切除术中3种浓度罗哌卡因行竖脊肌平面阻滞的镇痛效果比较[J]. 中国计划生育学杂志,2023,31(6):1321-1325.
[12] 李萌盟,王静,马志卫,等. 右美托咪定联合腹横肌平面阻滞对老年腹腔镜胆囊切除患者心血管应激的影响[J]. 河北医药,2023,45(3):395-398.
[13] 金晓伟,王和节,蒋毅. 竖脊肌平面阻滞与腹横肌平面阻滞用于腹腔镜全子宫切除术围术期镇痛的效果比较[J]. 浙江医学,2020,42(12):1310-1313,1317.
[14] YANG R Z, LI Y Z, LIANG M, et al. Stellate ganglion block improves postoperative sleep quality and analgesia in patients with breast cancer: a randomized controlled trial[J]. Pain Ther, 2023, 12(2):491-503.
[15] ZHU G, KANG Z, CHEN Y, et al. Ultrasound-guided stellate ganglion block alleviates stress responses and promotes recovery of gastrointestinal function in patients[J]. Dig Liver Dis, 2021, 53(5):581-586.
[16] WANG H B, JIA Y, ZHANG C B, et al. A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery[J]. Anaesthesia, 2023, 78(5):571-576.
[17] 于婷, 散小虎, 刘海英, 等. 星状神经节阻滞对腹腔镜下全子宫切除患者术后胃肠功能恢复的影响[J]. 江苏医药, 2023, 49(3):284-287.