经脐单孔腹腔镜联合腹横肌平面神经阻滞在妇科手术中的应用  

Application of transumbilical single-port laparoscopy combined with transversus abdominis plane nerve block in gynecological surgery

作　　者：刘慧敏 殷俊 周凤 LIU Hui-min;YIN Jun;ZHOU Feng(Department of Gynecology,Shenzhen Bao'an District Fuyong People's Hospital,Shenzhen 518103,Guangdong,CHINA;Department of Anesthesiology,Shenzhen Bao'an District Fuyong People's Hospital,Shenzhen 518103,Guangdong,CHINA)

机构地区：[1]深圳市宝安区福永人民医院妇科,广东深圳518103 [2]深圳市宝安区福永人民医院麻醉科,广东深圳518103

出　　处：《海南医学》2022年第4期482-485,共4页Hainan Medical Journal

基　　金：广东省深圳市宝安区科技计划项目(编号:2020JD045)。

摘　　要：目的探究经脐单孔腹腔镜联合腹横肌平面(TAP)神经阻滞在妇科手术中的应用效果。方法选择2019年1月至2021年2月深圳市宝安区福永人民医院收治的90例拟行经脐单孔腹腔镜妇科手术的患者作为研究对象,根据随机数表法将患者分为TAP神经阻滞组(A组)、罗哌卡因切口局部浸润组(B组)和对照组各30例。A组患者在麻醉诱导后予TAP神经阻滞处理,B组患者在术后给予罗哌卡因切口局部浸润处理,对照组无镇痛处理。比较三组患者术后12 h、24 h、48 h、96 h视觉模拟评分法(VAS)、术后恢复指标(下床时间、排气时间、住院时间)及术后不良反应发生情况(恶心呕吐、头痛头晕、创口瘙痒、嗜睡)。结果A组患者术后12 h、24 h的VAS评分分别为(1.91±0.89)分、(1.43±0.77)分,与B组术后12 h、24 h的(1.88±1.03)分、(1.51±0.81)分比较差异均无统计学意义(P>0.05),但A组和B组均明显低于对照组的(3.12±1.23)分、(2.55±1.41)分,差异均有统计学意义(P<0.05);A组患者术后48 h的VAS评分为(0.72±0.48)分,明显低于B组和对照组的(1.19±0.65)分、(1.91±1.03)分,且B组明显低于对照组,差异均有统计学意义(P<0.05);术后96 h,三组患者的VAS评分比较差异无统计学意义(P>0.05);A组患者术后下床时间、住院时间分别为(55.89±5.98)min、(3.78±0.56)d,明显短于B组的(68.13±6.12)min、(5.21±0.64)d和对照组的(103.42±7.21)min、(7.92±0.58)d,差异均有统计学意义(P<0.05);三组患者术后排气时间比较差异无统计学意义(P>0.05);A组和B组患者术后不良反应总发生率分别为6.67%,13.33%,差异无统计学意义(P>0.05),但A组与B组患者的不良反应总发生率明显低于对照组的36.67%,差异有统计学意义(P<0.05)。结论经脐单孔腹腔镜联合腹横肌平面神经阻滞在妇科手术中的应用能够有效缓解患者的术后疼痛感,有利于术后康复,值得临床推广。Objective To explore the effect of transumbilical single-port laparoscopy combined with transverse abdominis plane(TAP)nerve block in gynecological surgery.Methods A total of 90 patients who underwent transumbilical single-port laparoscopic gynecologic surgery admitted to Shenzhen Bao'an District Fuyong People's Hospital from January 2019 to February 2021 were selected as the research objects.According to random number table method,they were divided into group A,group B,and control group,with 30 patients in each group.Patients in group A were treated with TAP nerve block after anesthesia induction,patients in group B were treated with local infiltration of ropivacaine incision after operation,and those in the control group had no analgesia treatment.The visual analogue scale(VAS),postoperative recovery indexes(time for getting out of bed,exhaust time,and length of hospital stay),and the incidence of postoperative adverse reactions(nausea and vomiting,headache and dizziness,wound pruritus,and sleepiness)were compared among the three groups at 12 h,24 h,48 h,and 96 h after operation.Results The VAS scores of patients at 12 h and 24 h after operation in group A were(1.91±0.89)points and(1.43±0.77)points,respectively,which were not significantly different from(1.88±1.03)points and(1.51±0.81)points in group B(P>0.05);but the scores in group A and group B were significantly lower than(3.12±1.23)points,(2.55±1.41)points in the control group(P<0.05).The VAS score of patients at 48 hours after operation in group A was(0.72±0.48)points,which was significantly lower than(1.19±0.65)points and(1.91±1.03)points in group B and the control group;the score in group B was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).At 96 h after operation,there was no significant difference in VAS scores among the three groups(P>0.05).The postoperative time for getting out of bed and length of hospital stay in group A were(55.89±5.98)min and(3.78±0.56)d,which were significa

关 键 词：妇科手术 经脐单孔腹腔镜 腹横肌平面神经阻滞 不良反应 应用效果 麻醉 

分 类 号：R713[医药卫生—妇产科学]