超声引导下腹横肌平面两点阻滞在高危老年患者腹股沟疝修补术中的应用  

Ultrasound-guided two-point block of transverse abdominal muscle plane in high-risk elderly patients undergoing inguinal hernia repair

作　　者：朱尤壮 柴军[1] 杨福全[2] 孟相真[2] 徐琨[2] 康艺涵 秦上媛 Zhu Youzhuang;Chai Jun;Yang Fuquan;Meng Xiangzhen;Xu Kun;Kang Yihan;Qin Shangyuan(Department of Anesthesiology,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Colorectal Hernia,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004 [2]中国医科大学附属盛京医院结直肠疝外科,沈阳110004

出　　处：《中华普通外科杂志》2021年第11期835-840,共6页Chinese Journal of General Surgery

基　　金：辽宁省科技厅计划项目(2020JH2/10300129)。

摘　　要：目的探讨超声引导下侧路腹横肌平面(transversus abdominis plane,TAP)阻滞联合髂腹下/髂腹股沟TAP阻滞在高危老年患者腹股沟疝修补术中的应用效果。方法择期行腹股沟疝修补术高危老年男性患者60例,随机分为两组:超声引导下侧路TAP阻滞联合髂腹下/髂腹股沟TAP阻滞组(联合组)和侧路TAP阻滞组(侧路组)。比较两组手术切皮(T_(1))、打开腹外斜肌腱膜(T_(2))、游离疝囊(T_(3))、分离腹膜前间隙和置入补片(T_(4))、缝合腹横筋膜(T_(5))、缝合腹外斜肌腱膜(T_(6))、皮肤切口闭合(T_(7))时的疼痛视觉模拟评分(visual analogue scale,VAS);比较术后2、4、6、8、12和24 h静息和活动时VAS评分;比较补救镇痛药的累计消耗量;比较不良事件的发生情况。结果T_(3)~T_(5)时联合组VAS疼痛评分低于侧路组(P<0.05)。术后4、6和8 h联合组活动时VAS评分低于侧路组(P<0.05)。术后24 h内两组静息时VAS评分的比较,差异无统计学意义(P>0.05)。联合组补救镇痛药的累计消耗量低于侧路组(P<0.05)。两组不良事件的比较,差异无统计学意义(P>0.05)。结论超声引导下腹横肌平面两点阻滞可作为一种安全的术中替代性镇痛方法。Objective To investigate the effect of ultrasound-guided transversus abdominis plane(TAP)block combined with iliohypogastric/ilioinguinal TAP block in high-risk elderly patients undergoing inguinal hernia repair.Methods Sixty male patients undergoing elective inguinal hernia repair,aged≥70 years,BMI 18-23 kg/m^(2),ASAⅢ-Ⅳ grade,were randomly divided into two groups:ultrasound-guided lateral TAP block combined with iliohypogastric/ilioinguinal TAP block group(combined group)and lateral TAP block group(lateral group),with 30 cases in each group.In the combined group,the injection concentration of 0.375% ropivacaine 20 ml was at the iliohypogastric/ilioinguinal TAP puncture site and the lateral TAP puncture site was also 20 ml,and the lateral group only injected 0.375% 20 ml at the lateral TAP puncture site.The Visual Analogue Scale(VAS)of the two groups were compared at surgical skin incision(T_(1)),opening of external oblique aponeurosis(T_(2)),free hernia sac(T_(3)),separation of preperitoneal space and patch placement(T_(4)),suture of transverse abdominal fascia(T_(5)),suture of external oblique abdominal aponeurosis(T_(6))and skin incision are closed(T_(7));The VAS were compared during rest and activity at 2,4,6,8,12 and 24 hours after surgery.The cumulative consumption of relief analgesics was compared.Results Compared with the lateral group,the VAS of the combined group during T3-T5 was significantly lower(P<0.05).The VAS score at 4,6 and 8 hours after operation in the combined group was also significantly lower(P<0.05).There was no statistical significance in VAS score at rest between the two groups 24 h after operation(P>0.05).The cumulative consumption of relief analgesics in the combined group was lower(P<0.05).The difference of adverse events between the two groups was not statistically significant(P>0.05).Conclusion In high-risk elderly patients,ultrasound-guided transverse abdominal muscle plane two-point block can be used as a safe alternative method of intraoperative analgesia.

关 键 词：神经传导阻滞 疝 腹股沟 超声引导 老年患者 

分 类 号：R614[医药卫生—麻醉学]