腹横肌平面阻滞与伤口深部肌层局麻在肾移植受者术后镇痛中的对比研究  

Comparison of transverse abdominis plane block and deep wound local anesthesia in postoperative analgesia for kidney transplant recipients

作　　者：李其沛 刘晓明[2] 杜春恺 张健[2] 朱琛 Li Qipei;Liu Xiaoming;Du Chunkai;Zhang Jian;Zhu Chen(Department of Anesthesiology,Capital Medical University,Beijing Friendship Hospital,Beijing 100050,China;Department of Urology,Capital Medical University,Beijing Friendship Hospital,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050 [2]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《国际外科学杂志》2023年第10期664-669,I0005,共7页International Journal of Surgery

摘　　要：目的评估术前使用腹横肌平面阻滞(TAPB)以及术中伤口深部肌层局部麻醉在改善肾移植受者术后疼痛的效果。方法采用回顾性研究方法,选取2020年1月—2023年6月于首都医科大学附属北京友谊医院接受同种异体肾移植手术的62名受者作为研究对象,根据受者接受镇痛方式的不同将其分为三组:A组(n=11)、B组(n=28)、C组(n=23)。A组受者术前采用TAPB麻醉,B组受者术中采用伤口深部肌层局部麻醉,C组受者采用常规麻醉。比较三组受者的人口学指标,术中情况,术后0、2、12、24 h疼痛视觉模拟评分(VAS),术后镇痛药物需求率,术后恢复进食时间,并发症发生率等资料。计量资料采用Shapiro-Wilk法检验其正态性,符合正态分布的计量资料以均数±标准差(±s)表示,组间比较采用方差分析,组间有差异的采用S-N-K法进行事后两两比较;不符合正态分布的计量资料以中位数(四分位间距)[M(Q1,Q3)]表示,组间比较采用Kruskal-Wallis H检验,组间有差异的采用Bonferroni法进行事后两两比较。计数资料组间比较采用χ^(2)检验或Fisher确切概率法。结果三组受者的人口学基线及术中情况等方面比较,差异均无统计学意义(P>0.05)。A组和B组受者术后0、2、12、24 h疼痛VAS评分均显著低于C组(P<0.001),其中0、24 h疼痛VAS评分A组和B组无差异,而2、12 h的疼痛VAS评分A组低于B组;A组和B组术后镇痛药物需求率也显著低于C组,其中术后非甾体抗炎药需求率A组低于B组;A组和B组术后恢复进食时间也显著早于C组,差异均具有统计学意义(P<0.05)。三组受者术后恶心呕吐、主要并发症比较,差异均无统计学意义(P>0.05)。结论术前TAPB以及术中伤口深部肌层局部麻醉可以有效减轻肾移植受者术后疼痛,减少镇痛类药物的使用,促进供者术后早期胃肠功能恢复,并不会增加术后并发症发生率。术中伤口深部肌层局部麻醉的镇痛效果基本与术前Objective To evaluate the effects of preoperative transversus abdominis plane block(TAPB)and intraoperative deep wound local anesthesia on improving postoperative pain in kidney transplant recipients.Methods A retrospective study was conducted on 62 recipients who underwent allogeneic kidney transplantation at Beijing Friendship Hospital,Capital Medical University from January 2020 to June 2023.The recipients were divided into three groups according to the different methods of postoperative analgesia:group A(n=11),group B(n=28)and group C(n=23).Group A received preoperative TAPB anesthesia,group B received intraoperative deep wound local anesthesia,and group C received conventional anesthesia.Demographic characteristics,intraoperative parameters,postoperative pain visual analog scale(VAS)scores at 0,2,12 and 24 hours,postoperative analgesic medication requirement,time to postoperative oral intake,and incidence of complications were compared among the three groups.The normality of measurement data was tested by Shapiro-Wilk method.Measurement data conforming to normal distribution were expressed as mean±standard deviation(±s).ANOVA was used for comparison between groups,and S-N-K method was used for pairwise comparison between groups with differences.Measurement data that did not conform to the normal distribution were expressed as the median(interquartile distance)[M(Q1,Q3)],Kruskal-Wallis H test was used for comparison between groups,and Bonferroni was used for pairwise comparison after the fact if there were differences between groups.The Chi-square test or Fisher exact probability method was used for comparison between data groups.Results There were no significant differences in demographic characteristics and intraoperative parameters among the three groups(P>0.05).The pain VAS scores at 0,2,12 and 24 h after surgery in group A and group B were significantly lower than those in group C(P<0.001),and the pain VSA scores at 0 and 24 h were no difference between group A and group B,while the pain VAS scores at

关 键 词：肾移植 镇痛 麻醉 全身 腹横肌平面阻滞 局部麻醉 

分 类 号：R699.2[医药卫生—泌尿科学] R614[医药卫生—外科学]