超声引导腹横肌平面阻滞对子宫动脉栓塞患者术后内脏痛的影响  

Effects of ultrasound-guided transversus abdominis plane block on postoperative visceral analgesia in patients following uterine artery embolization

作　　者：张军[1] 张光明[1] 钱刚[1] ZHANG Jun;ZHANG Guangming;QIAN Gang(Department of Anesthesiology,Tongren Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院麻醉手术科,上海200336

出　　处：《皖南医学院学报》2017年第6期589-591,共3页Journal of Wannan Medical College

摘　　要：目的:观察超声引导腹横肌平面阻滞对子宫动脉栓塞患者术后内脏痛的影响。方法:接受子宫动脉栓塞的患者54例,随机分为腹横肌平面阻滞联合患者自控镇痛(TAPB+PCIA)组和患者自控镇痛(PCIA)组,每组27例。TAPB+PCIA组患者于术后即刻超声引导下采取腹横肌平面阻滞经典入路,每侧给予0.22%甲磺酸罗哌卡因注射液30 mL;同时连接静脉镇痛泵并给药,镇痛泵配方:舒芬太尼2μg/kg加生理盐水至100 mL;患者自控镇痛(PCA)剂量2 mL,锁定时间10 min;首次剂量3mL。PCIA组患者于术后即刻连接静脉镇痛泵并给药(镇痛泵配方及设置同前)。观察并记录手术结束后1 h(T_1)、3 h(T_2)、6h(T_3)、12 h(T_4)、24 h(T_5)的无创血压(BP)、心率(HR)、血氧饱和度(SpO_2)、疼痛程度(VAS)。观察并记录各组PCIA使用量,不良反应(恶心呕吐、皮肤瘙痒、呼吸抑制)例数。记录术后24 h患者的总体镇痛满意度评分。结果:TAPB+PCIA组部分时点(T_3、T_4)VAS评分较PCIA组同时点下降。TAPB+PCIA组的PCIA使用剂量低于PCIA组,TAPB+PCIA组患者的恶心呕吐、皮肤瘙痒发生率低于PCIA组。TAPB+PCIA组患者的总体镇痛满意度高于PCIA组。结论:腹横肌平面阻滞联合患者自控镇痛与患者自控镇痛相比,镇痛效果好,静脉自控追加镇痛药物少,副作用低,患者满意度高;超声引导腹横肌平面阻滞对于子宫动脉栓塞术后内脏疼痛有抑制作用。Objective:To observe the effects of ultrasound guided transversus abdominis plane block on visceral pain in patients following uterine artery embolization.Methods:Fifty four patients undergoing uterine artery embolization were equally randomized into group of transversus abdominis plane block plus patient controlled intravenous analgesia(group TAPB+PCIA)and simple patient controlled intravenous analgesia(group PCIA).Patients in the group TAPB+PCIA bilaterally received30mL of0.22%ropivacaine mesylate by classical injection guided under ultrasonography after operation,and were simultaneously administered with analgesia pump(2μg/kg sulfentanyl diluted in100mL normal saline;PCA dose:2mL;lockout time:10min;initial dose:3mL).Patients in the group PCIA were given simple PCIA using the protocol as previous group.Then the two groups were observed by maintaining the blood pressure(BP),heart rate(HR),SpO2,VAS at1h(T1),3h(T2),6h(T3),12h(T4)and24h(T5)after the operation.The PCIA doses,adverse events(nausea,vomiting,pruritus,respiratory depression)and the overall analgesic satisfaction scores in24h following operation were recorded in all patients.Results:VAS scoring at T3,T4and PCIA doses were decreased in group TAPB+PCIA compared to group PCIA group.Patients in group TAPB+PCIA had lower incidences of nausea,vomiting and skin pruritus,and higher rate of satisfaction with the analgesia than those in group PCIA.Conclusion:TAPB+PCIA under ultrasonography may lead to better analgesic effect than simple PCIA,and has more advantages,including less requirement of analgesic supply,fewer complications,yet higher satisfaction with the analgesia,for relief of the postoperative visceral pain in patients after uterine artery embolization.

关 键 词：超声引导 腹横肌平面阻滞 患者自控静脉镇痛 子宫动脉栓塞 

分 类 号：R714.461[医药卫生—妇产科学] R614[医药卫生—临床医学]