超声引导下双侧腹横肌平面阻滞复合腹直肌鞘阻滞用于开腹结直肠癌术镇痛效果观察  

Postoperative analgesic effect of ultrasound-guided combination of bilateral transversus abdominis plane block with rectus sheath block in colorectal surgery

作　　者：罗瑶[1] 杨笛[1] 杨钦焱 魏新川[1] 刘杨[1] 马丁[1] 万永灵[1] LUO Yao YANG Di YANG Qin-yan WEI Xin-chuan LIU Yang MA Ding WAN Yong-lin(Department of Anesthesiology,Sichuan Academy of Medical Science ＆ Sichuan Provincial People＇s Hospital, Chengdu 610072, China)

机构地区：[1]四川省医学科学院.四川省人民医院麻醉科,四川成都610072

出　　处：《实用医院临床杂志》2017年第2期55-58,共4页Practical Journal of Clinical Medicine

摘　　要：目的观察超声引导下行双侧腹横肌平面阻滞复合腹直肌后鞘阻滞在开腹结直肠癌手术的镇痛效果及术后康复效果。方法将60例全麻下行开腹结直肠切除术患者用随机数字表法分成试验组(TR组)及对照组(C组)各30例,TR组给予腹横肌平面阻滞(TAPB)复合腹直肌鞘阻滞(RSB)及常规全身麻醉组,C组为常规全身麻醉组,两组术后均行静脉自控镇痛(PCIA)。比较两组术中及术后静脉自控镇痛(PCIA)中舒芬太尼用量、24 h镇痛泵按压次数、术后4、8、16、24、36、48 h静息及运动时视觉模拟评分(VAS评分)、肠蠕动肛门排气时间以及早期下床活动时间等早期康复指标。结果与C组比较,TR组术中、术后舒芬太尼用量较少(P<0.05),24 h镇痛泵按压次数少(P<0.01),术后4、8、16 h VAS评分,肠蠕动时间及早期下地时间少,差异均有统计学意义(P<0.05)。两组术中收缩压、舒张压、心率、SpO_2均在正常范围,组间比较差异无统计学意义(P>0.05)。TR组未见腹横肌平面阻滞穿刺引起的不良反应。结论超声引导下的腹横肌平面阻滞及腹直肌鞘阻滞定位准确,可减少术中及术后镇痛泵舒芬太尼用药量,对开腹结直肠癌手术患者术后镇痛效果好,肠蠕动,肛门排气及早期下床时间缩短,有助于患者早期恢复。Objective To observe the postoperative analgesic and recovery effect of ultrasound-guided combination of bilateral transversus abdominis plane block （ TAPB） with rectus sheath block （ RSB） in colorectal surgery .Methods Sixty patients undergoing an open colorectal resection were randomly divided into TR group or control group ,30 in each group .The TR group received ultrasound-guided combination TAPB with RSB after routine general anesthesia .The control group received routine general anesthesia alone .The patients in the both groups used patient-controlled intravenous analgesia （PCIA） after operation.The sufentanil dosage,PCIA demand, visual analogue scale （VAS score） in 4,8,16,24,36 and 48 h after surgery,and recovery time of peristalsis,passage of gas by anus and early ambulation were compared between the two groups .Results Compared to the control group , the sufentanyl dosage in the TR group was less during and after operation （ P 〈0.05 ） ,the 24 h PCIA demand was fewer （ P〈0.01 ） ,the VAS scores was lower after 4,8 and 16 h of operation and time of peristalsis and early ambulation was earlier （P〈0.05）.The postoperative systolic blood pressure （SBP）,diastolic blood pressure （DBP）,heart rate and SPO2 were all in normal range in the both groups and there were no statistic differences between the two groups （ P 〉0.05 ） .There were no complications related to the nerve block procedures in the TR group . Conclusion Ultrasound guided TAPB combined with RSB have accurate positioning .The treatment can reduce the use of sufentanil in operative and PCIA .It is good for postoperative analgesia of patients with open colorectal resection and shortens the recovery time of peristalsis and passage of gas by anus .All these can promote the recovery .

关 键 词：超声引导 腹横肌平面阻滞 腹直肌鞘神经阻滞 镇痛 早期康复 

分 类 号：R614.4[医药卫生—麻醉学]