腹横筋膜阻滞在腹腔镜直肠癌低位前切除术后镇痛中的应用  

Application of Transversus Abdominis Plane Block in Postoperative Analgesia for Laparoscopic Rectal Carcinoma Surgery

作　　者：马若兰 吴安石[2] 沈荐[3] 李敏哲[3] 石立新[1] 

机构地区：[1]首都医科大学附属北京口腔医院麻醉科,北京100050 [2]首都医科大学附属北京朝阳医院麻醉科,北京100020 [3]首都医科大学附属北京朝阳医院普外科,北京100020

出　　处：《中国微创外科杂志》2017年第12期1064-1067,1082,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金面上项目(81171025;81371199;81771139)

摘　　要：目的探讨腹横筋膜(transversus abdominis plane,TAP)阻滞在腹腔镜直肠癌低位前切除术后镇痛中的应用价值。方法选择2015年3月~2016年11月北京朝阳医院腹腔镜直肠癌低位前切除术68例,以随机数字表法分为2组。TAP组33例,麻醉插管后在超声引导下以0.375%罗哌卡因20 ml行双侧TAP阻滞;对照组35例,按同样方法注射等剂量生理盐水。比较2组术后2、4、8、12、24 h静态及动态疼痛数字评分(numeric rating scale,NRS),以及术后肠蠕动恢复(有肠鸣音)时间、术后首次下床活动时间、术后住院时间、围手术期治疗费用、术后并发症。结果与对照组相比,TAP组术后恢复肠鸣音早[(28.1±9.8)h vs.(35.6±9.4)h,t=-3.214,P=0.002],术后首次下床早[(1.7±0.6)d vs.(2.0±0.6)d,t=-2.030,P=0.046],术后住院时间短[(7.1±1.2)d vs.(7.8±1.7)d,t=-2.122,P=0.038]。TAP组术后2、4、8、12、24 h静态及动态疼痛NRS均显著低于对照组[2 h静态(3.3±0.8)分vs.(4.0±0.8)分,t=-3.922,P=0.000;4 h静态(2.8±0.9)分vs.(3.5±0.7)分,t=-4.090,P=0.000;8 h静态(2.5±0.6)分vs.(3.1±0.6)分,t=-4.535,P=0.000;12 h静态(2.4±0.6)分vs.(3.0±0.4)分,t=-5.074,P=0.000;24 h静态(2.3±0.7)分vs.(2.7±0.5)分,t=-3.239,P=0.002;2 h动态(4.1±1.0)分vs.(4.9±1.1)分,t=-3.261,P=0.002;4 h动态(3.9±0.8)分vs.(4.5±1.0)分,t=-3.001,P=0.004;8 h动态(3.5±0.8)分vs.(4.2±0.7)分,t=-3.742,P=0.000;12 h动态(3.2±0.8)分vs.(3.7±0.7)分,t=-3.350,P=0.001;24 h动态(2.6±0.7)分vs.(3.3±0.6)分,t=-4.706,P=0.000]。2组术后并发症(恶心、呕吐、肠梗阻、消化道出血、切口感染、肺部感染、心力衰竭)发生率差异无统计学意义(P>0.05)。结论 TAP阻滞能为腹腔镜直肠癌低位前切除术提供良好的术后镇痛,有利于术后恢复。Objective To investigate the clinical value of transversus abdominis plane （TAP） block in postoperative analgesia for laparoscopic rectal carcinoma surgery. Methods A total of 68 patients with rectal carcinoma receiving laparoscopic rectal carcinoma surgery were recruited for the study. These cases were obtained from Beijing Chaoyang Hospital. All the patients were randomly divided into two groups, 33 patients for TAP group and 35 for control group. For TAP group, 0.375% ropivacaine was used in ultrasound-guided bilateral TAP block after anesthesia induction, while the same dose of normal saline was used for control group. Perioperative events （ recovering time of intestinal peristalsis, postoperative leaving bed time, and hospital stay） , postoperative complications, postoperative static and dynamic pain numerical rating scale （ NRS） at2h,4h,8h,12h, and 24 h were compared between the two groups. Results The TAP group had significantly shorter recovering time of bowel sound [（28.1±9.8） h vs. （35.6 ±9.4） h, t = -3.214,P= 0 . 002 ],postoperative leaving bed time [（1.7 ±0.6） d vs. （2. 0±0.6） d ,t = -2. 0 3 0 ,P= 0. 046 ] , and hospital stay [（7. 1±1.2） d vs. （7.8±1.7） d, t = - 2. 122 , P = 0. 038 ] than the control group. The postoperative 2 h,4h,8h,12h, and 24 h static and dynamic NRS of the TAP group were significantly lower than the control group [ static： 2 h, （3. 3 ± 0. 8） points vs. （4.0 ±0. 8） points, t = - 3. 922,= 0. 000 ; 4 h, （2 . 8 ±0.9） points vs. （3.5 ±0.7） points, t = -4. 090,P = 0. 000; 8 h, （2.5 ±0.6） points vs. （3.1 ±0.6） points, t = - 4. 535,P=0. 000; 12 h, （2. 4 ±0.6） points vs.（3. 0 ± 0. 4） points, t = - 5. 074 , = 0. 000 ;24h, （2.3±0.7） points vs. （2.7±0.5） points,t = - 3. 239 , P = 0. 002 ;dynamic ：2h, （4.1±1.0） points vs. （4.9±1.1） points, t = - 3. 261, P = 0. 002 ;4 h , （3.9 ±0.8） points vs.

关 键 词：腹横筋膜阻滞 术后镇痛 直肠癌 腹腔镜 

分 类 号：R614[医药卫生—麻醉学] R735.37[医药卫生—外科学]