超声引导腹横肌平面阻滞对子宫切除术患者术后镇痛和恢复的影响

Effects of ultrasound-guided transverses abdominis plane block on postoperative analgesia and recovery in patients following hysterectomy

关键词:  超声引导  腹横肌平面  神经传导阻滞  子宫切除术  镇痛

Key words:  ultrasound-guided  plane transverse abdominis muscle  nerve block  hysterectomy  analgesia

摘要:

目的 比较单纯全身麻醉和全身麻醉复合腹横肌平面阻滞对血流动力学、术后镇痛和恢复的影响,探讨腹横肌平面阻滞在子宫切除患者麻醉与术后镇痛的价值。方法 全身麻醉下行经腹子宫切除术患者50例,按照镇痛方式不同随机分为两组:腹横肌平面阻滞组(TAP组,n=24)和静脉镇痛组(PCIA组,n=26)。TAP组在诱导后行双侧TAP阻滞；PCIA组不行阻滞,术后行静脉镇痛。记录入室时、划皮前、划皮后5、10、15、60、90min各时点的MAP、HR,七氟醚、舒芬太尼用量,术后1、6、12、24、48h VAS评分及哌替啶用量,肠道功能恢复、进食、下床活动和住院时间以及不良反应发生情况,调查患者满意度。结果 与PCIA组比较,TAP组划皮前、划皮后5min MAP明显降低；七氟醚、舒芬太尼用量减少；术后1、6、12h VAS评分降低；哌替啶用量减少；肠道功能恢复、进食时间缩短；恶心呕吐例数减少(均P<0.05)。结论 超声引导TAP阻滞能显著减轻子宫切除术患者术后疼痛,减少阿片类用量及恶心呕吐概率,缩短肠道恢复和进食时间,患者满意度高。

Abstract:

Objective To investigate the effects of transverses abdominis plane block on hemodyn-amics, postoperative analgesia and recovery in patients following hysterectomy. MethodsFifty patients undergoing hysterectomy with general anesthesia were randomly divided into two groups:24 patients received ultrasound-guided bilateral transverse abdominis plane block (TAP) after induction and 26 patients received patient-controlled intravenous analgesia (PCIA). MAP, HR were recorded before anesthesia induction, before surgery, 5,0,15,0 and 90min after incision. The consumption of sevoflurane and sufentanil were compared. Postoperative visual analogue pain scale (VAS) at 1,6,12,4,48h and the amount of pethidine, recovery time of bowel function, eating, ambulation and length of hospital stay, adverse events, and patient satisfaction were evaluated. ResultsCompared with PCIA group, MAP in TAP group at 5min before and after incision, consumption of sevoflurane, sufentanil and pethidine decreased significantly. VAS scores at 1,6,12h were reduced (P<0.05). Recovery time of bowel function was shortened and the incidence of nausea and vomiting was reduced in TAP group (P<0.05). Conclusion Ultrasound-guided TAP block can alleviate the postoperative pain, reduce opioid consumption, the incidence of nausea and vomiting, shorten intestinal function recovery, and increase satisfaction of patients following hysterectomy.