超声引导腹横肌平面阻滞对开腹手术患者术后转归的影响
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摘要
目的探讨超声引导腹横肌平面阻滞(TAPB)对开腹手术患者术后转归的影响。方法选取我院2017年10月～2018年10月收治的60例开腹手术患者作为研究对象,按照随机数字表法分为T和C组,每组各30例。T组为TAPB组,术后采用TAPB+静脉自控镇痛(PCA);C组为对照组,术后采用PCA。比较两组术后不同时间点疼痛视觉模拟(VAS)评分、舒适度(BCS)评分、术后24 h PCA按压次数和患者对治疗的满意度、两组术后相关并发症发生情况。结果两组比较,在2、4、6、8、12 h时间点T组VAS评分明显低于C组(P<0.05),BCS评分高于C组(P<0.05),差异有统计学意义。24 h时间点两组VAS、BCS评分比较,差异无统计学意义(P>0.05)。比较两组术后镇痛泵按压次数,T组少于C组(P>0.05),治疗满意度T组高于C组(P<0.05),两组术后恶心呕吐发生率和呼吸抑制发生率比较,差异无统计学意义(P>0.05)。T组未观察到TAPB相关并发症的发生。结论超声引导TAPB符合精准麻醉和加速康复外科的理念,为开腹患者提供良好的镇痛效果,对疾病的转归产生积极的影响,值得临床大力推广。
Objective To observe the effects of ultrasound-guided transversus abdominis plane block(TAPB) on postoperative outcome of patients undergoing open abdominal surgery. Methods A total of 60 patients who underwent laparotomy in our hospital from October 2017 to October 2018 were selected as the study subjects, and they were divided into group T(30 cases) and group C(30 cases) according to random number table method. TAPB and patient-controlled intravenous analgesia(PCA) were performed after operation in group T. PCA was performed after operation in group C.Pain visual analogue scale(VAS),Bruggrmann comfort scale(BCS), PCA compression times, satisfaction degree and postoperative complications at different time points were compared between the two groups. Results VAS score in group T was significantly lower than in group C at 2, 4, 6, 8 and 12 hours(P<0.05), and BCS score was significantly higher than in group C(P<0.05). At 24 hours in group T and group C, VAS BCS scores were not statistically significant(P>0.05). Times of pressing analgesia pump in group C was higher than in group T(P<0.05), and satisfaction degree in group T was higher than in group C(P<0.05). There were no significant differences in incidence of nausea, vomiting and respiratory depression between group T and group C(P >0.05), and no complications of TAPB were observed in group T. Conclusion TAPB is consistent with precise anesthesia and enhanced recouery after surgery. It provides effective analgesic for open abdominal patients and positive impacts on the prognosis of abdominal surgery. It is worthy of promoting in clinical.
Objective To observe the effects of ultrasound-guided transversus abdominis plane block(TAPB) on postoperative outcome of patients undergoing open abdominal surgery. Methods A total of 60 patients who underwent laparotomy in our hospital from October 2017 to October 2018 were selected as the study subjects, and they were divided into group T(30 cases) and group C(30 cases) according to random number table method. TAPB and patient-controlled intravenous analgesia(PCA) were performed after operation in group T. PCA was performed after operation in group C.Pain visual analogue scale(VAS),Bruggrmann comfort scale(BCS), PCA compression times, satisfaction degree and postoperative complications at different time points were compared between the two groups. Results VAS score in group T was significantly lower than in group C at 2, 4, 6, 8 and 12 hours(P<0.05), and BCS score was significantly higher than in group C(P<0.05). At 24 hours in group T and group C, VAS BCS scores were not statistically significant(P>0.05). Times of pressing analgesia pump in group C was higher than in group T(P<0.05), and satisfaction degree in group T was higher than in group C(P<0.05). There were no significant differences in incidence of nausea, vomiting and respiratory depression between group T and group C(P >0.05), and no complications of TAPB were observed in group T. Conclusion TAPB is consistent with precise anesthesia and enhanced recouery after surgery. It provides effective analgesic for open abdominal patients and positive impacts on the prognosis of abdominal surgery. It is worthy of promoting in clinical.
引文
[1]叶太财,周良军,卫才权,等.腹横肌平面阻滞联合地佐辛对妇科手术患者术后镇痛效果的影响[J].现代医院,2017,17(3):421-424.
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[7]林玮,钱彬,林芩.超声引导腹横肌平面阻滞对腹腔镜胆囊切除患者术后恢复的影响[J].西部医学,2018,30(5):740-743.
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[9]张建华,卢先卿,何惠娇,等.全身麻醉复合超声引导下胸椎旁阻滞对开胸患者术后疼痛及应激反应的影响[J].中国当代医药,2018,25(6):12-16.
[10]葛有华.超声引导腹横肌平面阻滞在妇科手术中的应用[J].中国医药导刊,2014,16(8):1222-1223.
[11]窦青芳,颜廷轩,周乃宝,等.超声引导腹横肌平面阻滞辅助全身麻醉用于结直肠癌根治术临床观察[J].实用肿瘤学杂志,2018,58(20):85-87.
[12]易红,何睿,周大春.不同入路腹横肌平面阻滞的临床应用[J].临床麻醉学杂志,2016,32(5):510-514.
[13]Hebbard P,FujiwaraY,Shibata Y,et al.Ultrasound-guided transversus abdominis plane(TAP)block[J].Anaesth Intensive Care,2007,35(4):616-617.
[14]秦朝生,柳元铭,刘敬臣.腹横肌平面阻滞的应用进展[J].临床麻醉学杂志,2016,32(7):713-716.
[15]宋涛.腹横肌平面阻滞镇痛对腹腔镜结肠癌根治术患者早期恢复质量的影响[J].安徽医学,2017,38(3):324-327.
[16]阳文杰,马想明,黄强,等.腹横肌平面阻滞对结直肠肿瘤患者术后快速康复的影响[J].浙江医学,2016,38(17):1433-1438.
[2]Marques EM,Jones HE.EIvers KT,et al.Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement:systematic review and meta-analyses of shortand-long-term effecliveness[J].BMC Musculoskelet Disord,2014,15(8):220.
[3]代元强,文平山,陈君.超声引导下不同浓度罗哌卡因肋缘下入路腹横肌平面阻滞在上腹部手术中的效果[J].临床麻醉学杂志,2018,34(2):149-152.
[4]牟俊英,赵博,袁泉,等.超声引导腹横肌平面阻滞对无张力疝修补术后患者疼痛及生存质量的影响[J].实用医学杂志,2018,34(15):2541-2547.
[5]Tikuisis R,Miliauskas P,Lukoseviciene V,et al.Transversus abdominis plane block for postoperative pain relief after handassisted laparoscopic colon surgery:aradomized,placcebcon-teolled clinical trial[J].Tech Coloproctol,2016,20(12):835-844.
[6]李宗师,李哲,康志宇.超声引导腹横肌平面阻滞在结直肠癌根治术后镇痛的应用[J].实用肿瘤学杂志,2017,31(1):35-38.
[7]林玮,钱彬,林芩.超声引导腹横肌平面阻滞对腹腔镜胆囊切除患者术后恢复的影响[J].西部医学,2018,30(5):740-743.
[8]乔迎帅,卢锡华.超声引导腹横肌平面阻滞用于下腹部手术患者术后镇痛效果的观察[J].实用医学杂志,2015,31(7):1137-1139.
[9]张建华,卢先卿,何惠娇,等.全身麻醉复合超声引导下胸椎旁阻滞对开胸患者术后疼痛及应激反应的影响[J].中国当代医药,2018,25(6):12-16.
[10]葛有华.超声引导腹横肌平面阻滞在妇科手术中的应用[J].中国医药导刊,2014,16(8):1222-1223.
[11]窦青芳,颜廷轩,周乃宝,等.超声引导腹横肌平面阻滞辅助全身麻醉用于结直肠癌根治术临床观察[J].实用肿瘤学杂志,2018,58(20):85-87.
[12]易红,何睿,周大春.不同入路腹横肌平面阻滞的临床应用[J].临床麻醉学杂志,2016,32(5):510-514.
[13]Hebbard P,FujiwaraY,Shibata Y,et al.Ultrasound-guided transversus abdominis plane(TAP)block[J].Anaesth Intensive Care,2007,35(4):616-617.
[14]秦朝生,柳元铭,刘敬臣.腹横肌平面阻滞的应用进展[J].临床麻醉学杂志,2016,32(7):713-716.
[15]宋涛.腹横肌平面阻滞镇痛对腹腔镜结肠癌根治术患者早期恢复质量的影响[J].安徽医学,2017,38(3):324-327.
[16]阳文杰,马想明,黄强,等.腹横肌平面阻滞对结直肠肿瘤患者术后快速康复的影响[J].浙江医学,2016,38(17):1433-1438.