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目的观察B超引导下不同浓度罗哌卡因腹横肌平面阻滞应用于腹腔镜直肠癌根治术老年患者术后镇痛效果。方法回顾性分析台州市第一人民医院于2013年1月—2017年1月收治的需行腹腔镜直肠癌根治术老年患者90例临床资料,根据麻醉方式分为3组,3组均于全麻诱导后行B超引导下双侧腹横肌平面阻滞,A、B、C 3组分别注射0.10%、0.25%、0.50%盐酸罗哌卡因25 ml;术后均给予静脉镇痛泵:舒芬太尼0.8μg/kg+昂丹司琼16 mg+布托啡诺10 mg+生理盐水配置成100 ml,设置背景剂量2 ml/h,锁定时间15 min,Bolus剂量2 ml。观察3组麻醉前(T0)、术后1 h(T1)、术后12 h(T2)、术后24 h(T3)及术后48 h(T4)平均动脉压(MAP)及心率(HR)水平变化;并比较3组术后视觉模拟评分(VAS评分);记录术后24 h镇痛泵按压次数及舒芬太尼使用总量;比较3组术后不良反应。结果 A组术后1 h、术后12 h、术后24 h MAP及HR均高于B组、C组,且A组T1、T2、T3 MAP及HR均高于T0时刻(均P<0.05);B组T1时刻MAP及HR均高于C组(P<0.05),B组血流动力学更为平稳;A组T1、T2、T3、T4时刻VAS评分均低于B组、C组(均P<0.05),且B组、C组VAS评分比较差异无统计学意义(P>0.05);A组24 h内镇痛泵按压次数及舒芬太尼总量均高于B组、C组(均P<0.05);C组不良反应发生率高于A组及B组(P<0.05)。结论 B超引导0.25%罗哌卡因腹横肌平面阻滞应用于腹腔镜直肠癌根治术老年患者术后镇痛效果较佳,且不良反应发生率低。
Objective To observe the postoperative analgesic effect of B-ultrasonography on the rhabdomyosarcoma of the ropivacaine in patients undergoing laparoscopic radical mastectomy. Methods The clinical data of 90 elderly patients undergoing laparoscopic radical resection of rectal cancer admitted to the First People’s Hospital of Taizhou City from January 2013 to January 2017 were retrospectively analyzed. The patients were divided into 3 groups according to the mode of anesthesia. B-guided transthoracic block was induced by hemangiin in all cases. A, B and C groups were injected with 25% ropivacaine hydrochloride (0.10%, 0.25%, 0.50%, respectively) : Sufentanil 0.8 μg / kg + ondansetron 16 mg + butorphanol 10 mg + saline solution 100 ml, setting background dose 2 ml / h, locking time 15 min, Bolus dose 2 ml. The mean arterial pressure (MAP) and heart rate (HR) at 3 days before anesthesia (T0), 1 hour after operation (T1), 12 hours after operation (T2), 24 hours after operation (T3) and 48 hours ). The visual analog scale (VAS score) was compared among the three groups. The number of analgesia pump press and the amount of sufentanil used were recorded 24 hours after operation. The adverse reaction was compared between the three groups. Results The MAP and HR of group A at 1 h, 12 h and 24 h after operation were significantly higher than those of group B and C (P <0.05) ). MAP and HR in group B were higher than those in group C at T1 (P <0.05), and hemodynamics in group B were more stable. The VAS scores of group A at T1, T2, T3 and T4 were lower than those in group B and C (All P <0.05). There was no significant difference in VAS score between group B and group C (P> 0.05). The number of analgesia pump and the amount of sufentanil within 24 h in group A were higher than those in group B, C (both P <0.05). The incidence of adverse reactions in group C was higher than that in group A and B (P <0.05). Conclusion B-guided 0.25% ropivacaine on the transverse plane of flat muscle block in elderly patients undergoing laparoscopic radical resection of rectal cancer has better postoperative analgesia and low incidence of adverse reactions.