摘要
目的评价超声引导下腹横肌平面阻滞用于腹腔镜胆囊切除患者的术后镇痛效果。方法 90例择期腹腔镜胆囊切除术患者随机分为三组(R0.25组、R0.33组和C组),每组30例。三组患者均采用静吸复合全身麻醉。手术结束后,R0.25组与R0.33组行超声引导两点法腹横肌平面(transversus abdominis plane,TAP)阻滞,R0.25组每点注射0.25%盐酸罗哌卡因20 ml,两点共40 ml;R0.33组每点注射0.33%盐酸罗哌卡因15 ml,两点共30 ml;C组采用2μg/kg舒芬太尼静脉自控镇痛。应用视觉模拟评分(visual analogue scale,VAS)法评估疼痛强度,VAS>3分,静脉注射氟比洛芬酯50 mg镇痛补救;出现中度及以上程度恶心呕吐,静脉注射甲氧氯普胺(胃复安)10 mg。记录手术时间,麻醉诱导、麻醉维持药物用量;于出恢复室时(T1)、术后6h(T2)、24 h(T3)、48 h(T4)时记录疼痛评分;比较三组患者镇痛补救例数;术后恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应发生率。结果三组间麻醉诱导、麻醉维持用药量、手术时间差异无统计学意义。T1、T2、T4时三组疼痛强度差异无统计学意义;T3时R0.33组的VAS评分高于C组和R0.25组;需要镇痛补救例数较多(P<0.05),C组和R0.25组差异无统计学意义(P>0.05)。R0.25组和R0.33组恶心呕吐发生率明显减少(P<0.05)。三组术后均未见呼吸抑制,皮肤瘙痒等不良反应。结论超声引导下TAP阻滞用于腹腔镜胆囊切除术,具有较好术后镇痛效应,可降低术后恶心呕吐发生率,是一种有效、安全可行的神经阻滞镇痛措施。
Objective To investigate the postoperative analgesic effect of ultrasound-guided transversus abdominis plane （TAP）block in the patients undergoing laparoscopic cholecystectomy（LC）. Methods Ninty patients undergoing LC were randomly divided into 3 groups（ n = 30）. All the patients received intravenous inhalation combined general anesthesia in three groups. After the operation, the ultrasound-guided two-point approach transversus abdominis plane block were performed in R0.25 group and R0.33 group. The patients were administrated with 0.25% ropivacaine hydrochloride 20 ml each point（40 ml in total） in R0.25 group, 0.33% ropivacaine hydro- chloride 15 ml each point （30 ml in total） in R0.33 group, and the patient-controlled intravenous analgesia with 2 μg/kg sufentanil was administrated in control group. The pain intensity and postoperative nausea and vomiting（PONV） of patients were evaluated with visual analogue scale （VAS）. When the VAS score 〉 3, flurbiprofen axetil 50 mg was administrated intravenously for analgesia, and when me- dium or severe PONV occurred, metoclopramide 10 mg was administrated. The operation time, anesthetic induction dosage, maintenance dosage and VAS score were recorded when discharging from recovery room（ T1 ）, at 6 h（ T2 ）, 24 h（ T3 ） and 48 h（ T4 ） after operation. The cases of requiring extra analgesic, the incidence of PONV, respiration depression and skin pruritus were compared among three groups. Results The operation duration, anesthetic induction dosage and maintenance dosage showed no statistical significance among three groups （P 〉 0.05 ）. There was no difference in the pain intensity at TI, T2 and T4 （P 〉 0.05 ）. At T3, the VAS score in R0.33 group were more than those in control group and R0.25 group, and the patients requiring extra analgesic in R0.33 group was signifi- cantly higher than those in C group and R0.25 group （ P 〈 0.05 ）, but there was no statistical significance between control group and R0.25 group
出处
《山西医科大学学报》
CAS
2015年第2期185-189,共5页
Journal of Shanxi Medical University
基金
山西省卫生计生委科研基金资助项目(2014008)
关键词
超声引导腹横肌平面阻滞
腹腔镜
胆囊切除术
术后镇痛
ultrasound-guided transversus abdominis plane block
laparoscope
cholecystectomy
postoperative analgesia
