超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价  

Efficacy and evaluation of ultrasound-guided transverse abdominal muscle plane block in analgesia after laparoscopic cholecystectomy

作　　者：黄志强 张伟强[1] 邬文伟[1] 曾志文[1] HUANG Zhiqiang;ZHANG Weiqiang;WU Wenwei;ZENG Zhiwen(Department of Anesthesiology,Meizhou People's Hospital in Guangzhou Province,Meizhou514000,China)

机构地区：[1]广东省梅州市人民医院麻醉一科,广东梅州514000

出　　处：《中国现代医生》2020年第6期146-149,共4页China Modern Doctor

摘　　要：目的探讨超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效与评价。方法将2018年1月~2019年3月在我院肝胆外科行腹腔镜下胆囊切除术的60例患者随机分为两组,对照组使用气管插管全身麻醉,观察组使用气管插管全身麻醉联合超声引导下腹横肌平面阻滞,比较两组患者术后静息及咳嗽时的疼痛情况、术后镇静程度、不同时间点血压及心率变化、不良反应情况。结果在静息及咳嗽状态下,观察组出PACU时、术后4 h、术后24 h的VAS疼痛评分均明显低于对照组(P<0.05);观察组入PACU后5 min、10 min、15 min的镇静评分低于对照组(P<0.05),而入PACU后30 min的镇静评分无明显差异(P>0.05);两组在术中及入PACU后各时间点的MAP无明显差异(P>0.05),观察组在入PACU 10 min的心率慢于对照组(P<0.05),其他时间点无明显差异(P>0.05);观察组术后头痛、头晕、嗜睡、恶心呕吐、皮肤瘙痒、颤抖等不良反应发生率与对照组相比无明显差异(P>0.05)。结论超声引导下腹横肌平面阻滞在腹腔镜下胆囊切除术术后镇痛的疗效显著,对血流动力学影响小,安全性高,具有积极的临床意义。Objective To investigate the efficacy and evaluation of ultrasound-guided transverse abdominal muscle plane block in analgesia after laparoscopic cholecystectomy.Methods Sixty patients undergoing laparoscopic cholecystectomy in the department of hepatobiliary surgery in our hospital from January 2018 to March 2019 were randomly divided into two groups.The control group underwent general anesthesia using tracheal intubation.And the observation group underwent general anesthesia using tracheal intubation combined with ultrasound-guided transverse abdominal muscle plane block.The postoperative resting and cough pain,postoperative sedation degree,blood pressure and heart rate changes at different time points,and adverse reactions between two groups were compared.Results In the resting and coughing state,the VAS pain scores in the observation group at leaving PACU,4 hours after operation,and 24 hours after operation were significantly lower than those in the control group(P<0.05).The sedation scores of the observation group at 5 min,10 min,and 15 min after entering PACU were lower than those of the control group(P<0.05).There was no significant difference in sedation scores at 30 minutes after entering PACU(P>0.05).There was no significant difference in MAP between the two groups during operation and at each time point after entering PAC(P>0.05).The heart rate of the observation group at 10 minutes after entering PACU was slower than that of the control group(P<0.05),and there were no significant differences at other time points(P>0.05).There was no significant difference in the incidence of adverse reactions including postoperative headaches,dizziness,drowsiness,nausea and vomiting,skin itching,and tremors between the observation group and the control group(P>0.05).Conclusion Ultrasound-guided transverse abdominal muscle plane block has significant analgesic effect after laparoscopic cholecystectomy,and has little effect on hemodynamics,with high safety,which has positive clinical significance.

关 键 词：腹腔镜下胆囊切除术 术后镇痛 超声引导下腹横肌平面阻滞 疗效评价 

分 类 号：R614[医药卫生—麻醉学]