肋下入路腹横筋膜阻滞在老年患者胃造瘘术中的应用

目的 评价肋下入路腹横筋膜阻滞在老年患者胃造瘘术中的应用效果。方法 选择2017 年10 月～2019 年3 月行胃造瘘术的老年患者60 例，随机分为两组（n=30）：硬膜外麻醉组（E 组），肋下入路腹横筋膜阻滞组（S 组）。观察两组感觉阻滞起效时间、阻滞平面、麻醉满意率及术中腹部肌松情况，麻醉前（T0）、麻醉后10 min（T1）、手术开始后10 min（T2）及手术结束时（T3）平均动脉压（MAP）、指脉搏血氧饱和度（SpO2）；记录术中麻黄碱、舒芬太尼、利多卡因及术后地佐辛用量；记录不良事件发生情况。结果 两组感觉阻滞起效时间及麻醉满意率比较无差异，与S 组比较，E 组患者术中腹部肌松满意率更高；T1、T2的MAP 显著降低；T2的MAP 明显低于T0。E 组患者T1、T2、SpO2显著低于S 组；T1显著低于T0；麻黄碱的使用率明显高于S 组。两组患者术中舒芬太尼及利多卡因使用率差异无统计学意义（P＞0.05）。E 组患者术后使用地佐辛的例数显著高于S 组。两组患者均无不良事件发生。结论 超声引导肋下腹横筋膜阻滞用于老年患者胃造瘘手术麻醉，对呼吸循环系统影响小，不良反应少，同时可提供一定时间内的术后镇痛。

Application of abdominal transverse fascia block by subcostal approach in gastrostomy in elderly patients

Objective To evaluate the application effect of abdominal transverse fascia block by subcostal approach in gastrostomy in elderly patients.Methods Sixty elderly patients from October 2017 to March 2019 gastrostomy were se lected and randomly divided into two groups (n=30):an epidural anesthesia group (group E),and a transverse fascia block by subcostal approach group (group S).The sensory block onset time,block plane,anesthesia satisfaction rate,and abdominal muscle relaxation during surgery of both groups were observed.The mean arterial pressure (MAP),and pulse oximetry(SpO2) before anesthesia (T0),10 minutes after anesthesia (T1),10 minutes after the beginning of surgery (T2),and at the end of surgery(T3) were measured.The dosage of intraoperative ephedrine,sufentanil,lidocaine and postoperative dextrozine were recorded.The occurrence of adverse events was recorded.Results There was no difference in the onset time of sensory block and the anesthesia satisfaction rate between the two groups.Compared with group S,the satisfaction rate of abdominal muscle relaxation was higher in group E;the MAP of T1and T2was significantly decreased;the MAP of T2was significantly lower than that at T0.In group E,SpO2at T1and T2were significantly lower than those in group S;SpO2at T1was significantly lower than that at T0;the use rate of ephedrine was significantly higher than that in group S.There was no significant difference in the use rate of sufentanil and lidocaine between the two groups (P>0.05).The number of patients who used dizocine after surgery was significantly higher in group E than in group S.No adverse events occurred in either group.Conclusion Ultrasound-guided abdominal transverse fascia block by subcostal approach used in gastrostomy in elderly patients has little effect on the respiratory circulatory system and has fewer adverse reactions,and can also provide postoperative analgesia within a certain period of time.