摘要
目的分析术前双侧腹横肌阻滞(transversus abdominis plane block,TAPB)对腹部腔镜手术术后引起痛觉过敏的影响。方法选取90例自2017年5月~2019年4月本院收治的腹部腔镜手术患者作为研究对象,根据是否行双侧腹横肌阻滞及不同的瑞芬太尼血浆效应室浓度作为分组依据,将90例患者分为观察组、对照组、低浓度组。对照组30例患者瑞芬太尼血浆效应室浓度控制在4 ng/mL,观察组30例患者在对照组基础上复合双侧腹横肌阻滞,低浓度组30例患者在对照组基础上,瑞芬太尼血浆效应室浓度则采用2 ng/mL。对比三组患者术后肩部疼痛评分、手术切口周围痛域、前臂腹侧皮肤局部热刺激痛觉过敏及痛觉超敏区域及术后静注曲马多的剂量。结果术后第1天观察组患者切口周围痛域明显低于低浓度组和对照组(P<0.05);低浓度组前臂腹侧皮肤局部热刺激,痛觉过敏及痛觉超敏区域则明显低于观察组和对照组(P<0.05),观察组和对照组间则无明显差异(P>0.05);观察组术后24 h静注曲马多的平均需求量明显低于对照组和低浓度组(P<0.05);三组患者肩部疼痛评分,恶心、呕吐发生率没有明显差异(P>0.05)。结论术前双侧腹横肌阻滞(TAPB)能提供更好的术后镇痛,减少镇痛药的需求,但对术后痛觉过敏影响不大。
Objective To analyze the effect of preoperative bilateral transversus abdominis plane block(TAPB) on postoperative hyperpathia caused by laparoscopic abdominal surgery. Methods Ninety patients undergoing laparoscopic abdominal surgery in our hospital from May 2017 to April 2019 were recruited as research subjects. According to whether or not to perform bilateral transversus abdominis plane block and different plasma and effect-site concentrations of Remifentanil, the ninety patients were divided into the observation group, the control group, and the low concentration group. The plasma and effect-site concentration of Remifentanil in 30 patients in the control group was controlled at4 ng/mL, bilateral transversus abdominis plane block was performed in 30 patients in the observation group based on the control group, and the plasma and effect-site concentration of remifentanil in 30 patients in the low concentration group was 2 ng/mL based on the control group. Postoperative shoulder pain scores, pain threshold around the surgical incision,thermal stimulation of local skin in ventral forearm with hyperpathia area, allodynia area, and intravenous dosage of tramadol after operation were compared among three groups. Results On postoperative day one, the pain threshold around the surgical incision was significantly lower in the observation group than in the low concentration group and the control group(P<0.05);thermal stimulation of local skin in ventral forearm, hyperpathia area, and allodynia area were significantly lower in the low concentration group than in the observation group and the control group(P<0.05), and no significant difference between the observation group and the control group(P>0.05);the average demand for intravenous injection of tramadol 24 hours after operation was significantly lower in the observation group than in the low concentration group and the control group(P<0.05);no significant difference in shoulder pain score or incidence of nausea or vomiting among the three groups was found(P>0.05).
作者
陆辉
罗宁
LU Hui;LUO Ning(Department of Anesthesiology,Xiamen Haicang Hospital,Xiamen361026,China)
出处
《中国现代医生》
2020年第3期140-142,共3页
China Modern Doctor
关键词
腹横肌阻滞
腹部腔镜手术
瑞芬太尼
术后痛觉过敏
Transversus abdominis plane block
Laparoscopic abdominal surgery
Remifentanil
Postoperative hyperpathia
