摘要
目的观察氢吗啡酮联合腹横肌平面阻滞(TAPB)用于腹腔镜子宫全切术后镇痛的效果。方法选取择期全身麻醉下行腹腔镜子宫全切术患者60例,随机均分为三组。H组麻醉诱导后术前超声引导下给予0.375%罗哌卡因150mg双侧TAPB,手术开始前15min静脉推注氢吗啡酮20μg/kg;T组术前TAPB方法同H组;C组术前不行TAPB作为空白对照。记录三组术后1h(T1)、6h(T2)、12h(T3)、24h(T4)、48h(T5)VAS疼痛评分和Ramsay镇静评分,比较术后静脉自控镇痛(PCA)按压次数及不良反应。结果H和T组术后各时点VAS疼痛评分均低于C组(P<0.05);H组T1~T3时点VAS疼痛评分低于T组(P<0.05);H组PCA按压次数少于T、C组(P<0.05)。三组术后Ramsay镇静评分相仿(P>0.05)。三组患者术后均未出现皮肤瘙痒和呼吸抑制,术后恶心、呕吐等不良反应发生率差异无统计学意义(P>0.05)。结论氢吗啡酮联合TAPB有助于减轻腹腔镜子宫全切术患者术后疼痛,不影响镇静深度。
Objective To observe the analgesic efficacy of hydromorphone combined with transversus abdominis plane block（TAPB） in the patients undergoing laparoscopic hysterectomy. Methods Sixty cases of laparoscopic hysterectomy under general anesthesia were equally randomized into three groups. The ultrasound-guided bilateral TAPB with 0. 375% ropivacaine 150 mg was performed after anesthesia induction in groups of H and T. Hydromorphone 20 μg/kg was injected intravenously at 15 minutes before surgery in group H. Group C was taken as the blank control. The postoperative intravenous patient-controlled analgesia（PCA） was performed in three groups. The VAS pain score and Ramsay sedation score were evaluated in the 18t hour（T1）, 6th hour（T2）, 12th hour （T3）, 24th hour （T4） and 48th hour （TS） after operation. The postoperative adverse responses were compared among three groups. Results The VAS score at T1-T5 was lower in groups of H and T than that in group C （P〈0. 05 ）, which at T1-T3 was lower in group H than that in group T （P〈0. 05） and the PCA number of compression was less in group H than that in groups of T and C （P〈0. 05）. There was no significant difference after operation in Ramsay sedation score among three groups（P〈0. 05 ）. There was no significant difference in the incidence of nausea, vomiting, skin pruritus and respiratory depression among three groups （P〈0. 05）. Conclusion Hydromorphone combined with TAPB helps to reduce postoperative pain without affecting the depth of sedation in the patients undergoing laparoscopic hysterectomy.
作者
陈洁梅
冯海军
杨哲
马云
李华
CHEN Jiemei;FENG Haijun;YANG Zhe;et al(Department of Anesthesiology and Perioperative Medicine, Affiliated Suzhou Hospital, Nanjing Medical Uni versi ty , Suzhou 215153, CHINA)
出处
《江苏医药》
CAS
2018年第4期400-402,共3页
Jiangsu Medical Journal
关键词
氢吗啡酮
腹横肌平面阻滞
腹腔镜子宫全切术
镇痛
Hydromorphone
Transversus abdominis plane block
Laparoscopic hysterectomy
Analgesia
