| 超声引导下连续腹横肌平面阻滞在腹腔镜直肠癌根治术后多模式镇痛中的应用 |
| 投稿时间：2016-11-06 修订日期：2016-11-14 点此下载全文 |
| 引用本文：贺伟忠,闫国忠,张文学,闫小强.超声引导下连续腹横肌平面阻滞在腹腔镜直肠癌根治术后多模式镇痛中的应用[J].医学研究杂志,2017,46(7):152-155 |
| DOI：
10.11969/j.issn.1673-548X.2017.07.038 |
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| 中文摘要:目的 研究超声引导下连续腹横肌平面阻滞对腹腔镜直肠癌根治术术后镇痛的影响。方法 选择全身麻醉下行经腹腔镜直肠癌根治术患者72例，采用数字表法随机分为N组、T组，每组36例。两组均在术后给予舒芬太尼0.1μg/kg、帕瑞昔布钠40mg，并使用静脉患者自控镇痛（PCA）。T组在此基础上行双侧超声引导下腹横肌平面阻滞，并置入导管术后间断注射罗哌卡因注射液。比较两组返回SICU即刻（T1）、术后2h（T2）、6h（T3）、12h（T4）、24h（T5）的视觉模拟评分（VAS），术后24hPCA舒芬太尼使用总量及PCA情况，以及恶心、呕吐、皮肤瘙痒等不良反应发生情况。结果 T1、T2、T3、T4、T5时间点T组静息、运动VAS评分低于N组，差异有统计学意义（P<0.05）；T组24h舒芬太尼用量和PCA药液输注量低于N组，差异有统计学意义（P<0.05）；T组24hPCA自控按压有效次数少于N组，差异有统计学意义（P<0.05）；T组24h内恶心、呕吐、皮肤瘙痒发生例数及发生率低于N组，差异有统计学意义（P<0.01）。结论 超声引导下连续腹横肌平面阻滞可减轻腹腔镜下直肠癌根治术术后疼痛，减少阿片类药物使用，降低术后不良反应。 |
| 中文关键词:超声引导 腹横肌平面阻滞 直肠肿瘤 腹腔镜 多模式镇痛 |
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| Application of Ultrasound-guided Continuous Transversus Abdominis Plane Block in Multimodal Analgesia after Laparoscopic Radical Resection of Rectal Cancer |
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| Abstract:Objective To investigate the effects of ultrasound-guided continuous transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic radical resection of rectal cancer. Methods Seventy two patients receiving laparoscopic radical resection of rectal cancer were randomized, using the random number table, into the N group or T group each including 36 patients. Postoperatively, both groups were given sufentanil 0.1 μg/kg and parecoxib sodium 40mg, and received intravenous PCA. On this basis, group T additionally received bilateral ultrasound-guided TAPB, and intermittent drug infusion following catheterization. The two groups were compared for Visual Analogue Scale (VAS) score immediately at return to SICU (T1), and at 2h(T2), 6h (T3), 12h (T4), and 24h (T5) postoperatively, the total sufentanil dose for PCA and the PCA condition within 24h postoperatively, and for the incidence of the adverse reactions such as nausea, vomiting, and pruritis. Results The VAS scores at rest and at movement were lower in T group than in N group at T1, T2, T3, T4, and T5, with statistically significant differences (P<0.05). The total sufentanil dose and PCA drug infusion volume within 24h were lower in T group than in N group, with statistically significant differences (P<0.05). The number of effective PCA pump presses within 24h was lower in T group than in N group, with statistically significant difference (P<0.05). And both the number and proportion of patients experiencing nausea, vomiting or pruritis within 24h were lower in group T than in group N, with statistically significant differences (P<0.01). Conclusion Ultrasound-guided continuous TAPB could relieve pain after laparoscopic radical resection of rectal cancer, reduce the use of opioids, and reduce postoperative adverse reactions. |
| keywords:Ultrasound-guided transversus abdominis plane block Rectal neoplasms Laparoscopic surgery Multimodal analgesia |
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