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超声引导下RISS阻滞在微创McKeown食管癌根治术后的镇痛效果:一项前瞻性随机对照研究

罗富超 张俊华 程鹏 吴旌 钟斌 吕兵 黄国刚 刘洋 张泽学 韦晓红

罗富超, 张俊华, 程鹏, 吴旌, 钟斌, 吕兵, 黄国刚, 刘洋, 张泽学, 韦晓红. 超声引导下RISS阻滞在微创McKeown食管癌根治术后的镇痛效果:一项前瞻性随机对照研究[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2023-0358
引用本文: 罗富超, 张俊华, 程鹏, 吴旌, 钟斌, 吕兵, 黄国刚, 刘洋, 张泽学, 韦晓红. 超声引导下RISS阻滞在微创McKeown食管癌根治术后的镇痛效果:一项前瞻性随机对照研究[J]. 协和医学杂志. doi: 10.12290/xhyxzz.2023-0358
LUO Fuchao, ZHANG Junhua, CHENG Peng, WU Jing, ZHONG Bin, LYU Bing, HUANG Guogang, LIU Yang, ZHANG Zexue, WEI Xiaohong. Clinical Application of Ultrasound-guided RISS Plane Block for Postoperative Analgesia After Minimally Invasive McKeown Esophagectomy: A Prospective Randomized Controlled Study[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2023-0358
Citation: LUO Fuchao, ZHANG Junhua, CHENG Peng, WU Jing, ZHONG Bin, LYU Bing, HUANG Guogang, LIU Yang, ZHANG Zexue, WEI Xiaohong. Clinical Application of Ultrasound-guided RISS Plane Block for Postoperative Analgesia After Minimally Invasive McKeown Esophagectomy: A Prospective Randomized Controlled Study[J]. Medical Journal of Peking Union Medical College Hospital. doi: 10.12290/xhyxzz.2023-0358

超声引导下RISS阻滞在微创McKeown食管癌根治术后的镇痛效果:一项前瞻性随机对照研究

doi: 10.12290/xhyxzz.2023-0358
基金项目: 

重庆市涪陵区科卫联合医学科研项目(2022KWLH002)

详细信息
    通讯作者:

    张俊华, E-mail: 543090804@qq.com

  • 中图分类号: R614; R665.4

Clinical Application of Ultrasound-guided RISS Plane Block for Postoperative Analgesia After Minimally Invasive McKeown Esophagectomy: A Prospective Randomized Controlled Study

Funds: 

Science and Health Joint Medical Research Project of Chongqing Fuling District (2022KWLH002)

  • 摘要: 目的 探讨超声引导下菱形肌-肋间肌-低位前锯肌平面(rhomboidintercostal and subserratus plane,RISS)阻滞对微创McKeown食管癌根治术(minimally invasive McKeown esophagectomy,MIE-McKeown)患者术后镇痛的安全性和有效性,为微创食管癌手术患者术后镇痛方案选择提供新思路。 方法 前瞻性收集2022年3月—2023年6月于重庆大学附属涪陵医院胸心外科行MIE-McKeown术患者的临床资料,采用随机数字表法将入组患者分为A、B、C 3组: A组患者采用持续RISS阻滞+自控静脉镇痛(patient-controlled intravenousanalgesia,PCIA)策略,B组患者采用单次RISS阻滞+PCIA策略,C组采用单纯PCIA策略。记录并比较各组主要结局指标及次要结局指标:(1)镇痛效果[术后2 h、6 h、12 h、24 h、48 h的静息和咳嗽视觉模拟量表(visual analogue scale,VAS)疼痛评分]; (2)术后镇痛药物使用情况[术后24 h内舒芬太尼的用量、镇痛泵有效按压次数和补救性镇痛追加次数]; (3)术后镇痛期间不良反应发生情况(头晕、嗜睡、恶心呕吐、低血压、尿潴留等);(4)术中血流动力学指标[不同时间点的平均动脉压(mean arterial pressure,MAP)和心率];(5)镇痛满意度。其中(1)(2)(3)为主要结局指标,(4)(5)为次要结局指标。 结果 共96例符合纳入和排除标准的患者入选本研究,A、B、C每组各32人。A组患者术后2 h、6 h、12 h、24 h、48 h静息和咳嗽VAS评分均低于C组,且术后2 h、24 h的静息VAS评分及术后12 h、24 h的咳嗽VAS评分均低于B组; B组患者术后2 h、6 h、12 h的静息VAS评分及2 h、6 h、12 h、24 h、48 h的咳嗽VAS评分均低于C组,差异均具有统计学意义(P均<0.05)。术后24 h内舒芬太尼用量、镇痛泵有效按压次数及补救性镇痛的追加次数在A、B、C组之间逐渐增加,差异具有统计学意义(P均<0.001)。C组头晕、恶心呕吐的发生率分别高于A、B组(P均<0.05)。3组患者在麻醉诱导前(T0)、切皮即刻(T1)、切皮后5 min (T2)、拔管后5 min (T3)的MAP和心率差异均无统计学意义(P均>0.05)。A、B、C组镇痛满意度依次降低(P<0.05)。 结论 超声引导下RISS阻滞可为MIE-McKeown术患者提供良好的术后镇痛,作为多模式镇痛的积极探索,持续RISS镇痛效果更佳,值得临床进一步推广使用。
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出版历程
  • 收稿日期:  2023-08-02
  • 录用日期:  2023-11-28
  • 网络出版日期:  2023-12-11

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