摘要
目的探讨超声引导下腹横肌平面(TAP)阻滞和切口局麻药浸润在腹腔镜胆囊切除术后的镇痛效果。方法将择期行标准三口腹腔镜胆囊切除术的50例患者随机分为2组,每组25例。T组全麻诱导后超声引导下行右侧锁中线平行肋缘入路的TAP阻滞,注入0.25%罗哌卡因40 m L;A组于手术结束时切口用0.5%的罗哌卡因局部浸润。记录入室后、切皮前、气腹3 min的平均动脉压(MAP)及心率(HR),记录手术时间和术中瑞芬太尼的用量。分别于术后0、1、2、6和24 h对患者进行静息状态和咳嗽状态下的疼痛视觉模拟(VAS)评分,记录舒芬和曲马多的用量、恶心呕吐的发生率。结果术中瑞芬太尼的用量T组少于A组(P<0.05)。气腹3 min时T组的MAP和HR明显低于A组(P<0.05)。静息状态下各时点疼痛VAS评分无统计学差异(P>0.05),咳嗽状态下疼痛VAS评分在进入麻醉后苏醒室即刻、1 h和2 h时T组的评分低于A组(P<0.05),6 h和24 h时T组和A组间无统计学差异(P>0.05)。T组在麻醉后苏醒室内舒芬用量明显少于A组(P<0.05)。2组恶心呕吐的发生率无统计学差异(P>0.05)。结论锁中线平行肋缘位置的TAP阻滞用于腹腔镜胆囊切除术较切口局麻药浸润对静息状态下的疼痛影响无明显差异,但是可以减轻运动状态下的疼痛,可以减少阿片类药物的用量。
Objective To compare the postoperative analgesic effect of ultrasonography-guided transversus abdominis plane （TAP） block and lo- ca] wound infiltration in laparoscopic eholecystectomy （LC）. Methods Fifty patients who underwent LC were randomly assigned to receive TAP block （T group ） or local wound infiltration （A group ）. In group T, 40 mL of 0.25% ropivaeaine was administered in TAP block. In group A, 0.5% ropivacaine was injected around the trocar and extraction site. Mean arterial pressure （MAP） and heart rate （HR） were recorded at baseline, be- fore incision, and 3 min after pneumoperitoneum. The dosages of remifentanil and sufentanil and the incidence of postoperative nausea and vomit- ing （PONV） were also recorded. Visual analogue scale （VAS） scores for resting and coughing states were assessed at 0, 1,2,6, mad 24 hours af- ter operation. Results Compared with group A, the dosage of remifentanil was less, and MAP and HR at 3 rain after pneumoperitoneum were sig- nificantly lower in group T （P 〈 0.05 ）. No significant diffel^ence was found in VAS score at resting state. In group T, the VAS scores at coughing state in the postanesthesia care unit immediately, 1 h, and 2 h after operation were lower than those in group A （P 〈 0.05 ）. The sufentanil dosage was less in group T than in group A （P 〈 0.05 ）. No significant difference was found in the incidence of PONV. Conclusion The postoperative analgesic effect of TAP block is the same as that in local wound infiltration. However, it can reduce the pain score in the movement state and re- duce the opioid dosages.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2017年第8期694-697,共4页
Journal of China Medical University
基金
辽宁省社会发展攻关计划(2012225021)
关键词
腹横肌平面阻滞
超声引导
腹腔镜胆囊切除术
transversus abdominis plane block
ultrasound-guided
laparoscopic cholecystectomy
