腹横肌平面阻滞对经腹全子宫切除术的效果评价  

Evaluation of the effect of transversus abdominis plane block in transabdominal hysterectomy

作　　者：葛建岭[1] 杨勇[1] 徐成[1] 王芳 鲁美静 王伟[1] GE Jianling;YANG Yong;XU Cheng;WANG Fang;LU Meijing;WANG Wei(Department of Anesthesiology, The First People’s Hospital of Chuzhou, Chuzhou 239000, Anhui, China;Department of Gynecology, Clinical College, Anhui Medical University, Chuzhou 239000, Anhui, China;The First Affiliated Hospital of Southern Anhui Medical College, Wuhu 241001, Anhui, China)

机构地区：[1]滁州市第一人民医院麻醉科,安徽滁州239000 [2]安徽医科大学滁州临床学院妇科,安徽滁州239000 [3]皖南医学院第一附属医院麻醉科,安徽芜湖241001

出　　处：《西部医学》2021年第2期254-257,共4页Medical Journal of West China

基　　金：安徽省科技厅自然科学基金(110406M169)。

摘　　要：目的探讨腹横肌平面(TAP)阻滞用于经腹全子宫切除术的麻醉效果。方法选择2018年3月~2019年12月于滁州市第一人民医院接受经腹全子宫切除术的患者90例,通过随机数表法分为观察组和对照组各45例。对照组于全麻下完成手术,观察组在对照组基础上,在全麻诱导结束后联合TAP阻滞麻醉。比较两组围术期情况、术中血流动力学、术后镇痛情况及不良反应。结果两组手术时间、术中出血量、睁眼时间、拔管时间、住院时间比较差异无统计学意义(P>0.05);观察组切皮后5min(T1)、切皮后30min(T2)、术毕(T3)时点平均动脉压(MAP)、心率(HR)均明显低于对照组(P<0.05);观察组术后2h(T4)、6h(T5)、12h(T6)时点视觉模拟评分法(VAS)评分低于对照组,且术后24h镇痛泵按压次数、舒芬太尼用量均明显比对照组低(P<0.05);两组恶心呕吐、瘙痒、头晕头痛、嗜睡、呼吸抑制发生率比较差异无统计学意义(P>0.05)。结论TAP阻滞用于经腹全子宫切除术的麻醉效果显著,可有效避免术中血流动力学的剧烈波动,缓解术后疼痛,安全性好,可在临床应用推广。Objective To study the anesthesia effect of transverse abdominal plane(TAP)block in transabdominal hysterectomy.Methods 90 patients with total abdominal hysterectomy in Chuzhou Gaoshi first people's Hospital from March 2018 to December 2019 were selected and randomly divided into observation group and control group with 45 cases in each group.The control group completed the operation under general anesthesia,and the observation group was combined with tap block anesthesia after general anesthesia induction.The perioperative situation,intraoperative hemodynamics,postoperative analgesia and adverse reactions were compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss,eye opening time,extubation time and hospital stay between the two groups(P>0.05).The mean arterial pressure(map)and heart rate(HR)at 5 min(T1),30 min(T2)and the end of operation(T3)in the observation group were significantly lower than those in the control group(P<0.05).The VAS scores at 2 h(T4),6 h(T5)and 12 h(T6)after operation in the observation group were lower than those in the control group,and the pressing times of analgesia pump and the dosage of sufentanil at 24 h after operation in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of nausea,vomiting,pruritus,dizziness,headache,drowsiness and respiratory depression between the two groups(P>0.05).Conclusion The anesthesia effect of TAP block in transabdominal hysterectomy is significant,which can effectively avoid the violent fluctuation of hemodynamics and during operation and relieve the postoperative pain.

关 键 词：经腹全子宫切除术 腹横肌平面阻滞 血流动力学 应激反应 镇痛 

分 类 号：R614.2[医药卫生—麻醉学] R713.4+2[医药卫生—外科学]