中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (8): 694-697.doi: 10.12007/j.issn.0258-4646.2017.08.006

• 论著 • 上一篇    下一篇

超声引导下腹横肌平面阻滞和切口局麻药浸润在腹腔镜 胆囊切除术后镇痛效果的比较

龙波,孙唯韦,肖甄男,宋幽平   

  1. 中国医科大学附属盛京医院麻醉科,沈阳 110004
  • 收稿日期:2017-02-23 出版日期:2017-08-30 发布日期:2017-08-24
  • 通讯作者: 龙波 E-mail:longb@sj?hospital.org
  • 作者简介:龙波(1970 -),女,副主任医师,博士 .
  • 基金资助:
    辽宁省社会发展攻关计划(2012225021)

Postoperative Analgesic Effect of Ultrasonography-guided Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy:Comparison with Local Wound Infiltration

LONG Bo,SUN Weiwei,XIAO Zhennan,SONG Youping   

  1. Department of Anesthesiology,Shengjing Hospital,China Medical University,Shenyang 110004,China
  • Received:2017-02-23 Online:2017-08-30 Published:2017-08-24

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 mL;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。

关键词: 腹横肌平面阻滞, 超声引导, 腹腔镜胆囊切除术

Abstract: Objective To compare the postoperative analgesic effect of ultrasonography-guided transversus abdominis plane(TAP)block and local wound infiltration in laparoscopic cholecystectomy(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% ropivacaine 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,before incision,and 3 min after pneumoperitoneum. The dosages of remifentanil and sufentanil and the incidence of postoperative nausea and vomiting(PONV)were also recorded. Visual analogue scale(VAS)scores for resting and coughing states were assessed at 0,1,2,6,and 24 hours after operation. Results Compared with group A,the dosage of remifentanil was less,and MAP and HR at 3 min after pneumoperitoneum were significantly lower in group T(P < 0.05). No significant difference 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 reduce the opioid dosages.

Key words: transversus abdominis plane block, ultrasound-guided, laparoscopic cholecystectomy

中图分类号: 

  • R614.4
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