腹膜透析置管术中超声引导下腹横肌平面阻滞麻醉与局部麻醉比较的随机对照试验  

The application of transversus abdominis plane block anesthesia in peritoneal dialysis catheter implantation: a randomized controlled trial

作　　者：陶恬 李孜[1] 张文娟[2] 李崎[2] 唐晓红[1] 张杰[1] 

机构地区：[1]四川大学华西医院肾脏内科,成都610041 [2]四川大学华西医院麻醉科,成都610041

出　　处：《中国循证医学杂志》2017年第1期7-12,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的初步探讨超声引导下腹横肌平面(TAP)阻滞作为腹膜透析置管术麻醉方式的有效性及安全性。方法选择2015年4月~2016年2月期间四川大学华西医院肾脏内科拟行腹膜透析置管术的终末期肾病患者,对符合纳入标准者按1∶2的比例随机分为两组:局麻组接受局部浸润麻醉,TAP组接受超声引导下TAP阻滞麻醉。两组均先进行超声引导的TAP阻滞(局麻组为假操作),20分钟后再进行手术切口局部浸润麻醉(TAP组为假操作)。由麻醉医师按照随机分配序列对患者实施不同的麻醉方法,对手术医师、术中术后对患者进行VAS评分及并发症观察者和患者均采用盲法。所有患者随访至术后3月。观察患者因无法耐受而转换为全身麻醉的比率、术中及术后疼痛VAS评分、术中及术后追加镇痛药剂量、手术医生麻醉满意度、TAP阻滞相关并发症、麻醉药物不良反应、腹膜透析相关并发症和患者临床结局等指标。采用SPSS 19.0软件进行统计分析。结果共纳入36例患者,局麻组12例,TAP组24例。TAP组患者转全身麻醉比率为4.12%,显著低于局麻组(33.3%)(P=0.034)。TAP组VAS评分在手术切皮、分离皮下组织、牵拉及切开腹膜、置放腹膜透析管、缝皮、术后2小时、术后24小时各时点明显低于局麻组(P值均<0.05)。此外,TAP组术中追加镇痛药剂量明显低于局麻组(P=0.000),手术医生对于TAP组患者麻醉满意度明显高于局麻组。两组在腹透导管相关并发症、TAP相关并发症及麻醉药物的不良反应方面,差异无统计学意义。结论超声引导下腹横肌平面阻滞可作为腹膜透析置管术安全、有效的麻醉方式。但因本研究样本量较小,故上述结论有待更大样本的多中心前瞻性研究进行验证。Objective To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis （PD） catheter implantation. Methods Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups： the local filtration anesthesia （LF） group and the TAP group. The two groups got the ultrasound guided TAP block （The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound）, then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group （33.3%） （P=0.034）. The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF gr

关 键 词：腹膜透析置管术 超声引导下腹横肌平面阻滞麻醉 局部麻醉 随机对照试验 双盲 

分 类 号：R614[医药卫生—麻醉学]