B超引导下TAP阻滞复合全麻在妇科腹腔镜手术中应用  

The application of B ultrasonography guided TAP block combined with general anesthesia in gynecologic laparoscopic operation

作　　者：梁桂金 孟海兵 曹云[2] LIANG Guijin;MENG Haibing;CAO Yun(908 Hospital of joint logistic support department,PLA,Nanchang,JiangxiProvince,330000;Jiangxi Province People's Hospital)

机构地区：[1]中国人民解放军联勤保障部第九○八医院,南昌330000 [2]江西省人民医院

出　　处：《中国计划生育学杂志》2019年第5期612-615,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨B超引导下腹横肌平面(TAP)阻滞复合全麻在妇科腹腔镜手术中的应用。方法:2017年6月—2018年6月本院收治的全麻下行妇科腹腔镜手术62例作为研究对象,根据镇痛方法不同分为两组各31例,均给予静脉自控镇痛(PCIA),观察组在麻醉诱导后给予B超引导下双侧TAP阻滞,即注入30ml 0.25%盐酸罗哌卡因,对照组注入等容量生理盐水。比较两组镇痛药用量、术后恢复情况、术后疼痛评分及镇痛效果,并观察术后不良反应情况及患者满意度。结果:术后各个时间点观察组视觉模拟评分(VAS)均低于对照组,舒适度评分(BCS)均高于对照组(P<0.05), Ramsay镇静评分两组无差异(P>0.05);术中芬太尼用量、苏醒时间、气管插管拔除时间观察组均低于对照组(P<0.05),肛门排气时间及术后不良反应发生率两组比较无差异(P>0.05),镇痛满意度观察组高于对照组(P<0.05)。结论:B超引导下TAP阻滞复合全麻可使妇科腹腔镜手术芬太尼用量降低,术后镇痛效果提高,改善患者疼痛症状,降低不良反应发生率,提高患者满意度。Objective: To explore the application of B ultrasonography guided transversus abdominis plane (TAP) block combined with general anesthesia in gynecologic laparoscopic operation. Methods: 62 women who experienced gynecologic laparoscopic operation under general anesthesia from June 2017 to June 2018 were selected and divided into two groups according to the different methods of analgesia (31 cases in each group). The women in both groups were given patient controlled intravenous analgesia (PCIA). After induction of anesthesia, the women in study group were given bilateral TAP block (0.25% ropivacaine hydrochloride 30ml) guided by B ultrasonography, and the women in control group were injected with 30 ml normal saline. The dosage of analgesics, postoperative recovery situation, postoperative pain score, and analgesic effect were compared between the two groups, and the rate of adverse reactions and satisfaction degree of women were also observed. Results: The visual analogue scale (VAS) at different time points after operation of women in study group was significant lower than that of women in control group, but bruggrmann comfort scale (BCS) score was significant higher than that of women in control group ( P <0.05). There was no significant difference in Ramsay sedation score between the two groups ( P >0.05). The dosage of fentanyl, recovery time, and tracheal intubation time of women in study group were significant lower than those of women in control group, but the satisfaction degree of analgesia was significant higher than that of women in control group ( P <0.05). There was no significant difference in anal exhaust time and incidence rate of postoperative adverse reactions between the two groups ( P >0.05). Conclusion: B ultrasonography guided TAP block combined with general anesthesia for operation by gynecologic laparoscopy can significantly reduce fentanyl dosage, and can improve the effect of postoperative obviously, relieve pain symptoms, reduce the incidence of adverse reactions, and improve satisfact

关 键 词：腹腔镜手术 腹横肌平面阻滞 B超 麻醉 镇痛 

分 类 号：R614[医药卫生—麻醉学] R713[医药卫生—外科学]