摘要
目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中采取超声引导下腹横肌平面阻滞(transversus abdominis plane,TAP)联合罗哌卡因喷洒胆囊三角对患者术后谵妄及康复的影响。方法 选取2018年1月—2022年3月梅州市人民医院疼痛科收治的120例LC患者为研究对象,随机分为对照组(全麻)、TAP组、胆囊三角组与试验组(TAP联合罗哌卡因喷洒胆囊三角),各30例。记录插管即刻(T0)、划皮即刻(T1)、手术结束即刻(T2)及进麻醉后监测治疗室(postanesthesia care unit,PACU) 10 min(T3)、出PACU时(T4)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)。应用疼痛视觉模拟法(visual analogue scale,VAS)评估四组患者术后4、12、24 h的疼痛度,掌握术后谵妄发生情况,并记录复苏时间、首次下床时间、首次排气时间及术后住院天数。结果 通过监测,四组T0时MAP、HR比较,差异无统计学意义(P> 0.05),试验组T1~T4节点的MAP、HP均显著优于对照组、TAP组、胆囊三角组(P<0.05)。通过评估,试验组患者术后4、12、24 h的VAS评分均显著低于对照组、TAP组、胆囊三角组(P <0.05),TAP组低于对照组、胆囊三角组(P <0.05);但对照组、胆囊三角组间比较,差异无统计学意义(P> 0.05)。试验组术后复苏时间、首次下床时间、首次排气时间及术后住院天数均短于另外三组(P <0.05)。试验组术后谵妄发生率均显著对照组、TAP组、胆囊三角组(P <0.05)。结论 在LC麻醉中对患者采取TAP联合罗哌卡因喷洒胆囊三角麻醉,能有效稳定患者术中体征,减少术后谵妄发生,促进患者良好康复。
Objective To explore the effect of ultrasound guided transverse abdominal plane(TAP)combined with ropivacaine spraying gallbladder triangle on postoperative delirium and rehabilitation in laparoscopic cholecystectomy(LC).Methods A total of 120 patients who received LC treatment in department of pain of Meizhou People's Hospital from January 2018 to March 2023 were selected as the research objects,and were randomly divided into the control group(general anesthesia),TAP group,gallbladder triangle group and experimental group(TAP combined with ropivacaine spraying gallbladder triangle),all of which were 30 cases.MAP and HR were recorded immediately after intubation(T0),immediately after skin incision(T1),immediately after surgery(T2),10 minutes into PACU(T3),and at the time of exiting PACU(T4).The pain visual simulation method(VAS)was used to evaluate the pain levels of four groups of patients at 4,12,and 24 hours after surgery,to grasp the occurrence of postoperative delirium,and to record the recovery time,first time out of bed,first time exhaust and postoperative hospitalization days.Results Through monitoring,there was no significant difference in MAP and HR among the four groups at T0(P>0.05).The MAP and HP of the T1 to T4 nodes in the experimental group were significantly better than those of the other three groups(P<0.05).Through evaluation,the VAS scores of the experimental group patients at 4,12,and 24 hours after surgery were significantly lower than those of the control group,TAP group,and gallbladder triangle group(P<0.05).The TAP group was lower than the control group and gallbladder triangle group(P<0.05),but there was no significant difference between the control group and gallbladder triangle group(P>0.05).The experimental group had shorter postoperative recovery time,first time out of bed,first time exhaust,and postoperative hospitalization days compared to the other three groups(P<0.05).The incidence of postoperative delirium in the experimental group was significantly higher than that in the control group,TAP group,and gallbladder triangle group(P<0.05).Conclusion In LC anesthesia,TAP combined with ropivacaine spraying gallbladder triangle anesthesia can effectively stabilize the patient's signs during operation,reduce postoperative delirium and complications,and promote the patient's good recovery.
作者
黄志强
邹科
黄钻富
张伟强
赖尚导
HUANG Zhiqiang;ZOU Ke;HUANG Zuanfu;ZHANG Weiqiang;LAI Shangdao(Department of Pain,Meizhou People's Hospital,Meizhou Guangdong 514000,China)
出处
《中国卫生标准管理》
2023年第21期104-108,共5页
China Health Standard Management
关键词
腹横肌平面阻滞
罗哌卡因
胆囊三角
腹腔镜胆囊切除术
谵妄
康复
transversus abdominis plane
ropivacaine
gallbladder triangle
laparoscopic cholecystectomy
delirium
recovered
