在患有心力衰竭失偿症的儿科患者中插入PD导管的外周神经阻塞:一个病例报告
Jeanne Pauline W Orbe1, Lina May C Osit1
1Philippine General Hospital, University of the Philippines Manila.
Acta medica Philippina
|October 3, 2025
概括
周围神经阻塞 (PNB) 为儿科末期病 (ESRD) 患者提供安全的麻醉,这些患者正在接受腹腔透析 (PD) 导管插入. 这种技术提供了有效的疼痛控制,并避免了与危急儿童全身麻醉相关的风险.
科学领域:
- 麻醉学 麻醉学
- 儿科重症监护 儿科重症监护
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 周围神经阻断 (PNB) 是一种可行的麻醉选择,用于腹腔透析 (PD) 导管插入,特别是在重症患者中.
- 患有末期脏病 (ESRD) 和心力衰竭的重症儿科患者对PD导管安置具有独特的麻醉挑战.
研究的目的:
- 描述一个体重不足的儿科患者的麻醉管理ESRD和心力衰竭不补偿接受PD导管插入的PD导管插入.
- 为了评估单侧横向腹部平面 (TAP) 块和对侧直肠 (RS) 块作为唯一麻醉技术的联合安全性和有效性.
主要方法:
- 一名患有ESRD和心力衰竭的18岁男性接受了使用布皮瓦卡因与上腺素的左侧TAP阻塞和右侧RS阻塞.
- 用Remifentanil输液维持镇静状态.
- 在整个手术过程中,患者保持清醒和血液动力学稳定.
主要成果:
- 患者很好地忍受了手术,保持清醒和舒适,不需要血管压缩剂或转换为全身麻醉.
- 术后疼痛得分较低 (1/10),患者在医院第二天成功启动PD.
- 单侧TAP和对侧RS阻断技术的组合有效地提供了麻醉和止痛,最大限度地降低了局部麻醉剂 (LA) 容量和毒性风险.
结论:
- 单侧TAP与对侧RS阻塞是一种安全有效的麻醉技术,用于接受PD导管插入的重症儿科患者.
- 这种方法可以避免这种脆弱人群的全身或神经轴麻醉的血液动力学不稳定性风险.
- 该技术确保了令人满意的麻醉和术后疼痛控制,减少局部麻醉毒性的风险.
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