超声引导下腹横肌平面阻滞联合喉罩全麻在老年患者下腹部手术中的应用  

Application of ultrasound-guided transversus abdominis plane block combined with general anesthesia with LMA in elderly patients undergoing low abdominal surgery

作　　者：付群[1] 阮加萍[1] 李青[1] 茆庆洪[1] 石金云[1] 潘晨晨[1] 

机构地区：[1]南京中医药大学附属中西医结合医院江苏省中西医结合医院麻醉科,南京市210028

出　　处：《临床麻醉学杂志》2015年第8期747-749,共3页Journal of Clinical Anesthesiology

摘　　要：目的 观察超声引导下腹横肌平面阻滞（transversus abdominis plane block,TAPB）联合喉罩全麻在老年患者下腹部手术中的临床效果。方法 拟行腹股沟疝修补术或阑尾切除术老年患者40例,年龄〉65岁,随机数字表法均分为TAPB组（T组）和对照组（C组）。麻醉诱导后置入Supreme喉罩,在超声引导下行手术侧TAPB,分别注入0.375%罗哌卡因15ml（T组）或等容量生理盐水（C组）。记录麻醉药用量、苏醒时间和拔喉罩时间,以及术后2h（T1）、6h（T2）、12h（T3）、24h（T4）、48h（T5）的静态和动态VAS疼痛评分。记录不良反应发生情况。结果 与C组比较,T组丙泊酚、瑞芬太尼用量明显减少,苏醒时间、拔喉罩时间明显缩短（P〈0.05）;T1~T4时静态和T1~T5时动态VAS疼痛评分明显降低（P〈0.05）。两组患者术后不良反应差异无统计学意义。结论与单纯静脉全麻相比,TAPB联合喉罩全麻用于老年患者下腹部手术可减少麻醉药用量,缩短恢复时间,不增加不良反应。Objective To investigate effects of ultrasound-guided transversus abdominis plane block （TAPB） combined with general anesthesia with LMA in elderly undergoing low abdominal surgery. Methods Forty ASA Ⅰ - Ⅲ patients, aged 〉 65 years, undergoing low abdominal surgery were randomly divided into group T and group C （n= 20 each）. Ultrasound-guided TAPB was performed at the side of operation after insertion of laryngeal mask. Ropivacaine or saline was injected in group T and group C respectively. The anesthesia and operation time, propofol and remifentanil doses, recovery and LMA removal time were recorded. Pain at rest and at movement was evaluated using VAS score at 2,6,12,24 and 48 h （T1-T5） after surgery. Incidences of nausea and vomiting, sore throat, respiratory depression, complications of TAPB, analgesic rescue rates and bed time were recorded. Results Compared with group C, propofol and remifentanil doses were decreased, recovery and LMA removal time were shortened in group T significantly （P〈0.05）. Compared with group C, VAS scores at rest at T1-T4 and at movement at TI-T5 were significantly decreased in group T （P〈 0.05）. Compared with group C, analgesic rescue rates were lowered in group T significantly （P〈 0. 05）. No significant difference for adverse effects between two groups. Conclusion Compared with total intravenous anesthesia with LMA, uhrasound-guided TAPB combined with general anesthesia with LMA could reduce anesthetic doses and shorten recovery time in elderly undergoing low abdominal surgery with. no more adverse effects.

关 键 词：腹横肌平面阻滞 喉罩 老年 下腹部手术 

分 类 号：R614[医药卫生—麻醉学]