摘要
目的对比后路及肋缘下腹横平面阻滞（TAP）对全身麻醉下行开腹胃癌根治术后静脉镇痛效果的影响。方法40例美国麻醉医师协会评分标准（ASA）I～Ⅱ级择期胃癌根治术的患者，在手术结束后，按随机数字表法分为两组。在超声引导下，后路组（P组）在肋骨下缘与髂嵴间的腋中线行TAP，肋缘下组（S组）沿肋缘在剑突与髂嵴连线行TAP。双侧腹壁分别给予20rnl0．375％罗哌卡因，同时复合患者自控静脉镇痛（PCIA）。评估术后2．6、12、24h疼痛视觉模拟评分（VAS）及24h内PCIA的首次按压时间，按压次数及舒芬太尼消耗量及相关不良事件发生率。结果术后2h，针刺痛觉减退平面达到最大，S组为T7-L1，P组为T9-L1；半数以上患者痛觉减退平面比较：4h时S组为T8～T12，P组为T7～L1；6hS组为-19～T11，P组为T10～T12；12hS组为T9～T11，P组为T10-T12；24hS组为T9-T10，P组为T11。术后2、6h，S组的静息痛及运动痛VAS评分均显著低于P组，而术后12、24h两组差异无统计学意义（P〉0．05）。24h内静脉镇痛泵的首次按压时间、按压次数及舒芬太尼用量，S组显著少于P组（P〈0．05）。结论经肋缘下TAP较后路TAP，感觉阻滞部位更高，范围更广，作为胃癌根治术等上腹部手术的术后静脉镇痛的辅助方式更有优势。
Objective To evaluate the effectiveness of subcostal and posterior TAP block in analgesia for patients undergoing elective open radical gastrectomy. Methods At the end of the operation, 40 adult patients who are scheduled for elective open radical gastrectomy, are randomized to different group. Patients in Group P received an ultrasound - guided posterior TAP block using 20 ml of 0. 375% ropivacaine on each side. Group S underwent a subcostal TAP block with same solution. PCIA had also been applied. The severity of pain evaluated by VAS during rest and movement, were assessed at 2, 6, 12 and 24 - hour intervals postoperatively. The bolus, gross consumption of sufentanil were accounted. Results The maximum dermatomal block distribution was observed at 2 h after operation. The subcostal approach produced a broader rang （ T7 - T1 ）, while posterior is T9 - L1. The rang of sensory block n group S is 1 - 2 more cephalatic level compared with group P at 4 h （ T8 - T12 ： T7 - LI ）, 6 h （ T9 - T11 ： T10 - T12）, 12 h （T9 -T11：T10 -T12）, 24 h （T9 -T10：T11 ）. Patients received subcostal TAP block had significantly lower median pain scores both at rest and on movement than posterior ones at 2 h and 6 h post- operatively, meanwhile, no differences at 12 h and 24 h. The cumulative consumption of sufentanil and needs for bolus in 24 hours were significantly decreased in Group S compared with Group P. Conclusion Subcostal TAP block could provide a broader maximum sensory block distribution and a better alternative for comprehensive postoperative analgesia for supra - umbilical surgery, such as elective open radical gas- trectomy, while compared with the posterior approach.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2015年第8期2019-2021,共3页
Chinese Journal of Experimental Surgery
基金
吉林省直卫生专项项目（3D514L463430）
关键词
麻醉
腹横肌平面
疼痛
手术后
外周神经阻滞
Anesthesia
Transversus abdominis plane
Pain postoperative
Peripheral regional anesthesia
