超声引导腹横肌平面阻滞用于改善腹腔镜胆囊切除术后镇痛质量的临床观察  

Ultrasound-guided subcostal transversus abdominis plane block improves quality of analgesia after laparoscopic cholecystectomy

作　　者：张学政[1] 王权光[1] 周颖[1] 吴一泉[1] 杨沛[1] 陈丽梅[1] 徐旭仲[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《北京医学》2013年第4期275-277,共3页Beijing Medical Journal

摘　　要：目的观察超声引导肋缘下腹横肌平面阻滞联合静脉吗啡镇痛对腹腔镜胆囊切除术后早期恢复质量的影响。方法选择行择期腹腔镜胆囊切除者70例,随机分为腹横肌平面阻滞联合吗啡镇痛组(TM组)与吗啡镇痛组(M组),各35例。全麻诱导后,超声引导双肋缘下腹横肌平面注射,TM组每侧予0.375%罗哌卡因20ml,M组每侧予生理盐水20ml。采用VAS评分法评估术后2、6、24h静息及咳嗽时疼痛强度和术后24h内吗啡总用量。记录术后相关指标及镇痛满意度。结果 TM组术后2、6、24h咳嗽VAS评分分别为27±13、28±12及34±15,均低于M组的50±19、59±22及47±20(P<0.05);24h吗啡总用量TM组为(15±9)mg显著低于M组(27±11)mg(P<0.01);恢复室留观时间TM组为(28±16)min,M组为(43±19)min(P<0.01);进饮更早,术后因疼痛导致的睡眠中断次数TM组与M组分别为(2.5±1.9)次vs.(4.0±2.8)次(P<0.05),提高了术后镇痛满意度(P<0.01)。结论与单纯吗啡自控镇痛相比,加用腹横肌平面阻滞更有利于腹腔镜胆囊切除的术后镇痛,改善术后恢复质量。Objective To evaluate the effects of ultrasound-guided subcostal transversus abdominis plane block （TAPB） combined with patient-controlled intravenous morphine analgesia on recovery quality at early stage after laparoscopic cholecystectomy. Methods Seventy patients undergoing laparoscopic cholecystectomy were randomly allocated into Group TM （n=35） and Group M （n=35）. Ultrasound-guided bilateral subcostal TAPB was performed following induction of general anesthesia. Solution was injected into transversus abdominis plane on each side with 20 ml of 0.375% ropiracaine in Group TM or 20 ml saline in Group M. VAS scores at rest and on coughing were scaled at 2 h, 6 h, and 24 h after surgery, as well as total consumption of morphine during postoperative 24 h. The recovery quality related manifestations were recorded and the patients＇ satisfaction for postoperative analgesia was measured. Results VAS score on coughing at each time point was significantly lower and the total morphine consumption was less in Group TM than in Group M. Patients in Group TM had shorter duration of postoperative care unit stay, earlier water intake, less incidence of sleep interruption by pain and relatively higher satisfaction of analgesia compared with those in Group M. Con- clusion The ultrasound-guided subcostal TAPB combined with patient-controlled intravenous morphine analgesia provides good analgesia effect and improves quality of recovery after laparoscopic cholecystectomy.

关 键 词：超声 腹腔镜胆囊切除术 镇痛 

分 类 号：R614[医药卫生—麻醉学]