摘要
目的探讨超声引导下腹横肌平面阻滞(transversus abdominis plane block,TAPB)在肠肿瘤开放术术后切口镇痛方面的有效性。方法全身麻醉下行腹直肌旁正中切口的肠肿瘤患者80例,ASA分级Ⅰ~Ⅲ级,用随机数字表法分为TAPB组(T组)和对照组(C组),每组40例。常规麻醉诱导后,吸入七氟醚维持麻醉,BIS值维持在40~60;T组患者在超声引导下行单侧TAPB,C组患者切皮前及关腹前各给予10μg舒芬太尼。比较两组患者术后PACU及术后2、6、12、24h静息及咳嗽状态时切口痛疼痛数字评分(Numerical Rating Scale,NRS)、镇痛泵累积按压次数、镇痛泵首次按压时间、T组患者术后切口痛出现时间及术后恶心呕吐(postoperative nausea and vomiting,PONV)评分。结果T组患者静息NRS评分在术后PACU[0分比(2.9±1.1)分]、术后2h[0分比(3.1±0.7)分]、术后6h[(1.2±0.5)分比(3.7±0.9)分]低于C组(P<0.05);T组患者镇痛泵累积按压次数在术后PACU[0次比(1.1±0.7)次]、术后2h[(0.5±0.9)次比(2.0±1.2)次]、术后6h[(1.7±1.1)次比(4.5±2.3)次]、术后12h[(4.5±2.2)次比(8.5±3.3)次]、术后24h[(8.1±3.3)次比(12.8±3.1)次]少于C组(P<0.05);T组患者PONV评分在术后PACU[0分比(2.1±0.9)分]、术后2h[0分比(1.7±0.8)分]、术后6h[0分比(2.2±0.6)分]、术后12h[(0.9±0.6)分比(2.2±0.7)分]、术后24h[0分比(2.1±0.9)分]低于C组(P<0.05)。结论超声引导下TAPB能提供良好的术后切口镇痛,减少术后阿片类药物的应用,降低PONV评分。
Objective To evaluate the postoperative analgesic effect of transversus abdominis plane block (TAPB) under guidance of ultrasonic in the anesthesia of intestinal surgeries on intestinal tumor patients.Methods Eighty patients undergoing intestinal tumors with lateral rectus incision,American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ were randomly devided into two groups:group TAPB (group T,n =40) and group control (group C,n =40).After induction of general anesthesia,anesthesia was maintained with sevoflurane to keep the Bispectral Index (BIS) value within 40-60.In group T,one side TAPB was performed under ultrasound guidance.In group C,10 μg sufentanil was given both at the time point of incision and before peritoneal closure.Numerical Rating Scale (NRS) pain scores,pressing times of patient-controlled infusion analgesia (PCIA),postoperative nausea and vomiting (PONV) scores were recorded at designed time points postoperative [post-anesthesia care unit (PACU),2,6,12,24 h].Results NRS scores in group T were lower than those in group C at postoperative PACU (0 vs 2.9±1.1),postoperative 2 h (0 vs 3.1±0.7),postoperative 6 h (1.2±0.5 vs 3.7±0.9,P<0.05).Cumulative pressing times of PCIA in group T were less than those in group C at postoperative PACU (0 vs 1.1±0.7),postoperative 2 h (0.5±0.9 vs 2.0±1.2),postoperative 6 h (1.7±1.1 vs 4.5±2.3),postoperative 12 h (4.5±2.2 vs 8.5±3.3) and postoperative 24 h (8.1±3.3 vs 12.8±3.1,P<0.05).PONV scores in group T were significantly lower than those in group C at postoperative PACU (0 vs 2.1 ±0.9),postoperative 2 h (0 vs 1.7 ±0.8),postoperative 6 h (0 vs 2.2±0.6),postoperative 12 h (0.9±0.6 vs 2.2±0.7) and postoperative 24 h (0 vs 2.1±0.9,P<0.05).Conclusions TAPB could provide better analgesia effect,reduce postoperative dosage of opioids and the PONV scores.
作者
李永华
羊黎晔
陈巍
严晓娣
袁红斌
Li Yonghua;Yang Liye;Chen Wei;Yan Xiaodi;Yuan Hongbin(Department of Anesthesiology,Shanghai Changzheng Hospital,Shanghai 200003,China)
出处
《国际麻醉学与复苏杂志》
CAS
2019年第1期7-10,共4页
International Journal of Anesthesiology and Resuscitation
基金
国家自然科学基金(81671304,81873945)
上海市科委优秀技术带头人计划项目(17XD1424300).
关键词
腹横肌平面阻滞
肠肿瘤
切口痛
Transversus abdominis plane block
Intestinal cancer
Incision pain
