减重手术术前使用腹横肌平面阻滞可改善操作条件并缩短手术时间的临床研究  

Clinical study of preoperative transversus abdominis plane block improves surgical condition and reduces surgical time of bariatric surgery

作　　者：周莹 付强[1] 郑传东[1] 胡涛 杨华武[2] 刘雁军[2] Zhou Ying;Fu Qiang;Zheng Chuandong;Hu Tao;Yang Huawu;Liu Yanjun(Department of Anesthesiology,the Third People's Hospital of Chengdu,Sichuan Province,610015;Department of Gastrointestinal Surgery,the Third People's Hospital of Chengdu,Sichuan Province,610015)

机构地区：[1]成都市第三人民医院麻醉科,四川成都610031 [2]成都市第三人民医院胃肠外科,四川成都610031

出　　处：《消化肿瘤杂志（电子版）》2020年第3期208-211,215,共5页Journal of Digestive Oncology(Electronic Version)

摘　　要：目的本研究拟验证腹横肌平面阻滞(transversus abdominis plane block,TAPB)是否可改善减重手术的术中操作条件、缩短手术时间和减少肌肉松弛药物的剂量。方法本研究为单中心前瞻性观察性研究。根据纳入和排除标准收集了我院减重手术病例,根据术前是否采用TAPB,分为TAPB组(72例)和非TAPB组(63例)。使用单因素和多因素分析比较两组的手术操作条件、手术时长,术中腹压机超过18 cmH2O的次数,术中肌松药物的使用剂量以及术后疼痛的视觉模拟评分法(visual analogue scale,VAS)。结果本研究最终纳入135例病人,TAPB组与非TAPB组的基线数据基本平衡。校正年龄、性别、体质量指数、合并症以及手术方式等混杂因素后,TAPB与手术条件满意度(HR=1.72,95%CI 1.17~2.55,P=0.007)、手术时长(HR=0.83,95%CI 0.75~0.91,P<0.001)和术后30 min的疼痛评分(HR=0.64,95%CI 0.46~0.89,P=0.009)有关联,而与腹腔镜压力超过18 cmH2O的次数、肌松药物使用的总量以及术后6 h的疼痛评分之间的关系无统计学意义。结论TAPB对于手术操作条件、手术时长和术后30 min的疼痛具有积极作用。Objective We aim to explore whether preoperative transversus abdominis plane block(TAPB)block can improves surgical condition and reduces surgical time of bariatric surgery.Methods We conducted a single-center prospective observational study.Cases of our hospital were collected according to the inclusion and exclusion criteria.Two groups(TAPB and non-TAPB)were compared in surgical condition,surgical time,times of pressure>18 cmH2O from the abdominal pressure-creating machine,intraoperative rocuronium volume,and postoperative visual analogue scale with univariate and multivariate analysis.Result The study included 135 cases.The baseline data presented balance between TAPB and non-TAPB groups.After adjusted with age,gender,BMI,comorbidities and surgical type,TAPB was associated with improved surgical condition(HR=1.72,95%CI 1.17-2.55,P=0.007),surgical time(HR=0.83,95%CI 0.75-0.91,P<0.001),and 30 min postoperative visual analogue scale(HR=0.64,95%CI 0.46-0.89,P=0.009).No association of TAPB with times of pressure>18 cmH2O from the abdominal pressure-creating machine,intraoperative rocuronium volume,and 6 h postoperative visual analogue scale were observed.Conclusion TAPB has positive effect to surgical condition,surgical type and 30 min postoperative visual analogue scale.The study supports further generalization of TAPB are needed,which has potential of preventing the complication of surgery and facilitating rapid recovery.

关 键 词：减重手术 腹横肌平面阻滞 手术条件 手术时间 

分 类 号：R614[医药卫生—麻醉学]