TAPB联合RSB在腹腔镜全子宫切除术中的应用效果研究  

Effect of TAPB combined with RSB in laparoscopic total hysterectomy

作　　者：余佩霞 莫雪莹[1] Yu Peixia;Mo Xueying(Department of Anesthesiology,Guangxi Zhuang Autonomous Region People′s Hospital,Nanning 530000,China)

机构地区：[1]广西壮族自治区人民医院麻醉科,南宁530000

出　　处：《中华保健医学杂志》2023年第4期415-418,共4页Chinese Journal of Health Care and Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20211242)。

摘　　要：目的分析超声引导腹横肌平面阻滞(TAPB)联合腹直肌鞘阻滞(RSB)在腹腔镜全子宫切除术(LTH)中的应用效果及对视觉模拟自评量表(VAS)评分与舒适度量表(BCS)评分的影响。方法回顾性分析广西壮族自治区人民医院2020年1月~2021年6月住院的120例LTH手术患者,按照麻醉方法不同分为两组(每组60例),对照组给予TAPB,联合组给予TAPB联合RSB,比较两组右美托咪定、舒芬太尼、维库溴铵用量、血流动力学指标、临床镇静评分(Ramsay评分)、视觉模拟自评量表(VAS)评分、舒适度量表(BCS)评分、按压镇痛泵次数、不良反应总发生率。结果联合组右美托咪定、舒芬太尼、维库溴铵用量与对照组比较,差异无统计学意义(P>0.05);联合组T1(建立CO_(2)气腹时)、T2(手术开始30 min后)、T3(拔管10 min后)平均动脉压(MAP)、心率(HR)均低于对照组,差异有统计学意义(P<0.05)。联合组T4(术后6 h)、T5(术后12 h)、T6(术后24 h)Ramsay评分均高于对照组,VAS评分、BCS评分均低于对照组,差异有统计学意义(P<0.05)。联合组按压镇痛泵次数低于对照组,差异有统计学意义(P<0.05)。不良反应总发生率联合组(5.00%)与对照组(6.67%)比较,差异无统计学意义(P>0.05)。结论LTH术中给予TAPB联合RSB,在维持术中血流动力学稳定的同时,可有效减轻术后疼痛感、躁动程度,提高舒适度,减少镇痛泵按压次数,且麻醉期间未见明显不良反应,具有一定的安全性。Objective To analyze the application effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with rectus abdominis sheath block(RSB)in laparoscopic total hysterectomy(LTH)and its influence on visual analogue scale(VAS)score and comfort scale(BCS)score.Methods Retrospective analysis was made on 120 patients with LTH who were hospitalized in our hospital from January 2020 to June 2021.According to different method,they were divided into two groups(n=60 for each group).The control group was given TAPB,and the combined group was given TAPB plus RSB.The hemodynamic indexes,Ramsay score,VAS score,BCS score,times of pressing the analgesic pump,and the total incidence of adverse reactions were compared between the two groups.Results The mean arterial pressure(MAP)and heart rate(HR)of the combined group at T1(when CO2 pneumoperitoneum was established),T2(after 30 min of operation)and T3(after 10 min of extubation)were lower than those of the control group(P<0.05).The Ramsay scores of T4(6 h after operation),T5(12 h after operation)and T6(24 h after operation)in the combined group were higher than those in the comparison group(P<0.05).The T4,T5,T6 VAS scores and BCS scores of the combined group were lower than those of the control group(P<0.05).The Times of pressing analgesic pump in combination group was lower than that in comparison group(P<0.05).The total incidence of adverse reactions in the combined group(5.00%)was compared with that in the control group(6.67%)(P>0.05).Conclusion TAPB combined with RSB during LTH operation can effectively reduce postoperative pain and agitation,improve comfort and reduce the number of analgesic pump compressions while maintaining the stability of intraoperative hemodynamics.There is no obvious adverse reaction during anesthesia,which has a certain safety.

关 键 词：超声引导腹横肌平面阻滞 腹直肌鞘阻滞 腹腔镜全子宫切除术 疼痛 

分 类 号：R713[医药卫生—妇产科学]