超声引导下腹横肌平面阻滞麻醉用于腹腔镜下胆囊切除术术后镇痛的效果和安全性  

Analgesic efficacy and safety of ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy

作　　者：沈丽莉[1] 王苑[1] 王华婴 陈嘉生 王祥瑞[1] 殷文渊[1] SHEN Lili WANG Yuan WANG Huaying CHEN Jiasheng WANG Xiangrui Y/N Wenyuan(Department of Anesthesio/ogy , Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]上海市闵行区中心医院麻醉科

出　　处：《上海医学》2016年第10期579-583,F0003,共6页Shanghai Medical Journal

摘　　要：目的研究超声引导下腹横肌平面(TAP)阻滞麻醉用于腹腔镜胆囊切除术(LC)术后镇痛的效果和安全性。方法采用随机、对照、双盲原则将60例接受日间择期LC的患者分为3组,每组20例:对照组(不行TAP阻滞麻醉),术前TAP组(于LC术前20 min在超声引导下行双侧TAP阻滞麻醉,每侧注射0.375%罗哌卡因20 mL),术后TAP组(于LC术后在超声引导下行双侧TAP阻滞麻醉,每侧注射0.375%罗哌卡因20 mL)。在麻醉诱导前、气管插管即刻、切皮后3 min、手术开始10 min、术毕、入麻醉后监测治疗室(PACU)10 min、入PACU 30 min和出PACU各时间点,记录患者的平均动脉压(MAP)和心率(HR)。在出PACU和术后4、24 h各时间点,记录患者的疼痛视觉模拟评分(VAS评分)和术后恶心呕吐(PONV)评分。若术后疼痛VAS评分≥5分,则静脉注射曲马多50 mg,记录术后24 h各组追加曲马多的患者例数。结果 3组患者间各时间点的MAP和HR的差异均无统计学意义(P值均>0.05)。在出PACU时间点,3组间疼痛VAS评分的差异均无统计学意义(P值均>0.05);在术后4和24 h时间点,术前TAP组和术后TAP组的疼痛VAS评分均显著低于对照组(P值分别<0.05、0.01),前两组间的差异均无统计学意义(P值均>0.05)。3组间术后24 h追加曲马多的患者比例和各时间点PONV评分的差异均无统计学意义(P值均>0.05)。结论术后TAP阻滞麻醉能有效减轻LC患者术后4和24 h的疼痛,与术前TAP阻滞麻醉的镇痛效果相似,安全可行。Objective To investigate the safety and efficacy of ultrasound-guided post-operative transversus abdominis plane （TAP） block on analgesia in laparoscopic cholecystectomy （LC）. Methods Sixty patients scheduled for ambulatory LC were enrolled in this random controlled double-blind study. They were divided into 3 groups （n = 20）= control group （general anesthesia）, pre-TAP group （0. 375% ropivacaine 20 mL was injected on each side for ultrasound-guided TAP 20 minutes before LC）, and post-TAP group （0. 375 % ropivacaine 20 mL was administered on each side for ultrasound-guided TAP after LC）. The mean arterial pressure （MAP） and heart rate （HR） were recorded before anesthesia induction, at the moment of intubation, 3 minutes after resection, 10 minutes after resection, at the end of LC, 10 minutes in the post-anesthesia care unit （PACU）, 30 minutes in the PACU, and 60 minutes in the PACU. Patients visual analog scale （VAS） and postoperative nausea and vomiting （PONV） scores were assessed 60 minutes in the PACU, 4 hours after LC, and 24 hours after LC. Once VAS score was 5 and more, tramadol 50 mg were given intravenously, and the patients in whom tramadol was used were recorded. Results There were no significant differences in MAP or HR at any time point between groups.Although no statistical difference was found in VAS score when patients left PACU among the 3 groups （all P〈0.05）, VAS score in pre-TAP group and post-TAP group at 4 hours and 24 hours after LC were significantly lower than that in control group （P〈0.05, P〈0.01, respectively）. There was no significant difference in the VAS score between pre-TAP group and post-TAP group at any time points （both P〈0.05）. Moreover, no significant difference was found in the PONV score or tramadol consumption between groups （all P〈0.05）. Conclusion Post-operative TAP block can effectively alleviate pain at 4 hours and 24 hours after LC, which is similar to pre- operative TAP block. （Shanghai Med J, 2016

关 键 词：超声引导 术前腹横肌平面阻滞 术后腹横肌平面阻滞 腹腔镜胆囊切除术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]