超声引导腹横肌神经阻滞对老年女性卵巢癌术后镇痛的临床研究  

Efficacy of Ultrasound-guided Transversus Abdominis Plane Block for Postoperative Analgesia in Older Women with Ovarian Cancer

作　　者：田晓涛[1] 张宪宦 周姝[2] Tian Xiaotao;Zhang Xianhuan;Zhou Shu(Department of Anesthesiology,Fushun Mining Bureau General Hospital,Fushun 113008,China;Department of Anesthesiologv,Jilin Cancer Hospital,Changchun 130000,China)

机构地区：[1]抚顺矿务局总医院麻醉科,抚顺113008 [2]吉林省肿瘤医院麻醉科,长春130000

出　　处：《国际老年医学杂志》2019年第1期35-38,共4页International Journal of Geriatrics

摘　　要：目的探讨超声引导下腹横肌神经阻滞(TAPB)对于老年女性患者行卵巢癌手术术后镇痛的有效性、安全性及康复意义。方法选取2015-2017年在我院行卵巢癌根治术的65岁以上老年女性患者60例,随机分为实验组(30例)和对照组(30例)。实验组患者术前在超声引导下行双侧腹横肌神经阻滞,常规麻醉,术后给予静脉术后自控镇痛(PCIA);对照组患者术前不进行腹横肌神经阻滞的处置,常规麻醉,术后给予PC1A。记录两组患者一般资料和手术情况,以及在麻醉恢复室(PACU)、术后2h、4h、8h、12h、24h、48h各时间点静止及运动视觉模拟疼痛评分(VAS)和Ramsay镇静评分,PCIA按压时间点及次数,患者满意度,术后追加芬太尼给药时间、药量及用药次数,观察和统计不良反应的发生情况。结果两组患者一般资料和手术时间组间比较差异无统计学意义(P>0.05)实验组患者在PACU、术后24h内各时间点静止及运动VAS评分显著低于对照组(P<0.05),术后48h组间比较差异无统计学意义(P>0.05)。两组患者在各个时间点的Ramsay镇静评分差异无统计学意义(P>0.05)。实验组患者术后PCIA按压时间点明显晚于对照组且按压次数和需要额外追加芬太尼的病例数显著低于对照组<0.05)。实验组患者在术后镇痛期间满意率显著高于对照组且不良反应发生率显著低于对照组(Р<0.05)结论超声引导下腹横肌神经阻滞可安全用于老年女性患者行卵巢癌手术的术后镇痛,其镇痛效果突出,并可以明显减少镇痛药的用量,降低不良反应的发生率,提高患者满意度。Objective To investigate the efficacy, safety and rehabilitalion significance of ultrasound-guideil transversus abdominis plane block (TAPB) for postoperative analgesia in older women with ovarian cancer undergoing surgery.Methods 60 older women over the age of 65 undergoing radical surgery for ovarian canoer between 2015 and 2017 were selected.The patients were randomly divided into the experimental group and the control group.Bilateral TAPB, routine anesthesia and postoperative patient-controlled intravenous analgesia (PCIA) were performed in the experimental group.Routine anesthesia and postoperative PCIA were performed in the control group.The general data, surgical procedures, visual analogue pain score (VAS) at rest and movement at various time points after operation, Ramsay sedation score, analgesia consumption, patient satisfaction, use of fentanyl and adverse reactions were recorded.Results There was no significant difference in general data and operative time between tht1 two groups ( P > 0.05).In the experimental group, VAS scores within 24 hous after operation were significantly lower than those in the control group (P<0.05), however, there was no significant difference at 48 hours compared with the control group (尸>0.05).There was no significant difference in Ramsay sedation score between the two groups at all time points ( P >0.05 ).In the experimental group, the time of PCIA pressing after operation was significantly later than that in the control group, the number of times of pressing and the case number of additional fentanyl needed were significantly less than those in the control group (P< 0.05 ).The sidisfaction rate of patients was significantly higher and the incidence of adverse reactions was significantly lower in the experimental group during postopenitive analgesia than those in the control group ( P<0.05).Conclusion UItrasourul-guided TAPB can be used for older women undergoing surgen for ovarian cancer.The analgesic effect is prominent.It can reduce the consumption of analgesic drugs

关 键 词：超声 腹横肌神经阻滞 老年 卵巢癌 术后镇痛 

分 类 号：R737.31[医药卫生—肿瘤] R614[医药卫生—临床医学]