不同浓度布比卡因超声引导下行腹横肌平面阻滞对阑尾切除患者术后相关指标的影响  

Effects of Ultrasound-guided Transabdominis Plane Block of Different Concentrations of Bupivacaine on Related Indexes in Patients after Appendectomy

作　　者：刘佳 谢科宇[1] 谢先丰[1] LIU Jia;XIE Keyu;XIE Xianfeng(Dept.of Anesthesia,Chengdu Second People’s Hospital,Chengdu 610017,China)

机构地区：[1]成都市第二人民医院麻醉科,成都610017

出　　处：《中国药房》2018年第18期2532-2536,共5页China Pharmacy

基　　金：四川省卫生和计划生育委员会科研课题(No.18PJ164)

摘　　要：目的:比较不同浓度布比卡因超声引导下行腹横肌平面阻滞(TAPB)对阑尾切除患者术后相关指标的影响及安全性。方法:选择2017年3月-2018年3月我院收治的120例阑尾炎患者,按随机数字表法分为A、B、C、D组,每组各30例。所有患者手术结束即开始行超声引导下TAPB,A组患者注射0.35%布比卡因20 m L,B组患者注射0.25%布比卡因20 m L,C组患者注射0.15%布比卡因20 m L,D组患者注射0.9%氯化钠注射液20 m L,后均行静脉自控镇痛。观察4组患者行超声引导下TAPB后2 h(T_1)、4h(T_2)、8 h(T_3)、12 h(T_4)、24 h(T_5)、48 h(T_6)时在静息和咳嗽状态下的疼痛视觉模拟评分(VAS),术后镇痛满意度,曲马多使用率和镇痛泵按压次数,肛门排气时间和下床时间及不良反应发生情况。结果:T_2~T_5时,4组患者静息状态下的VAS评分均显著高于同组T_1、T_6时,并在T_3时达到最高值,随后逐渐降低,差异均有统计学意义(P<0.05),T_1与T_6时比较差异均无统计学意义(P>0.05);T_1~T_6时,A、B、C组患者的VAS评分均显著低于D组,差异均有统计学意义(P<0.05),但A、B、C组间比较差异均无统计学意义(P>0.05)。T_2~T_4时,4组患者咳嗽状态下的VAS评分均显著高于同组T_1时,并在T_3、T_4时达到最高值(D组为T_4时),而在T_5~T_6时均显著低于同组T_1时;T_1~T_6时,A、B、C组患者的VAS评分均显著低于D组,差异均有统计学意义(P<0.05),但A、B、C组间比较差异均无统计学意义(P>0.05)。A、B、C组患者术后镇痛满意度评分、镇痛满意度优的例数均显著高于或多于D组,曲马多使用率、镇痛泵按压次数均显著低于或少于D组,差异均有统计学意义(P<0.05),但A、B、C组间比较差异均无统计学意义(P>0.05)。4组患者肛门排气时间、下床时间及恶心呕吐、眩晕、瘙痒、尿潴留的发生率比较,差异均无统计学意义(P>0.05),且所有患者均未发生局部麻醉药相关的毒性反应。结论:阑尾切除术后�OBJECTIVE:To compare effects and safety of ultrasound-guided transabdominis plane block(TAPB)of different concentrations of bupivacaine on related indexes in patients after appendectomy.METHODS:Totally 120 appendicitis patients selected from our hospital during Mar.2017-Mar.2018 were randomly divided into group A,B,C,D,with 30 cases in each group.All patients received ultrasound-guided TAPB immediately after surgery.Group A was given 0.35%bupivacaine 20 mL intravenously;group B was given 0.25%bupivacaine 20 mL intravenously;group C was given 0.15%bupivacaine 20 mL intravenously;group D was given 0.9%Sodium chloride injection 20 mL intravenously,and then given patient controlled intravenous analgesia.The VAS scores of 4 groups in resting and cough state were recorded at 2 h(T1),4 h(T2),8 h(T3),12 h(T4),24 h(T5),48 h(T6)after ultrasound-guided TAPB.Satisfaction degree of postoperative analgesia,the rate of tramadol use,press times of analgesic pump,anal exhaust time,the time of getting out of bed and the occurrence of ADR were observed in 4 groups.RESULTS:At T2-T5,VAS scores of 4 groups in resting were significantly lower than same group at T1 and T6;at T3,VAS scores reached the highest value and then decreased gradually,with statistical significance(P<0.05);there was no statistical significance at T1 and T6(P>0.05).At T1-T6,VAS scores of group A,B and C were significantly lower than group D,with statistical significance(P<0.05);there was no statistical significance among group A,B and C(P>0.05).At T2-T4,VAS scores of 4 groups in cough state were significantly higher than same group at T1;at T3 and T4,VAS scores reached the highest value(group D at T4),at T5-T6,VAS scores were lower than same group at T1;at T1-T6,VAS scores of group A,B and C were significantly lower than group D,with statistical significance(P<0.05),but there was no statistical significance among group A,B and C(P>0.05).The score of analgesia satisfaction degree and the case number excellent analgesia satisfaction degree in group A,B and C were si

关 键 词：布比卡因 不同浓度 超声引导 腹横肌平面阻滞 阑尾切除术 镇痛 安全性 

分 类 号：R614.4[医药卫生—麻醉学] R656.8[医药卫生—外科学]