肋缘下腹横肌平面阻滞与切口局麻药浸润在腹腔镜结肠癌根治术术后镇痛的效果比较  

Comparison of the Effects of Subcostal Transversus Abdominis Plane Block and Incisional Local Anesthetic Infiltration for Postoperative Analge⁃sia in Laparoscopic Radical Surgery for Colon Cancer

作　　者：李鹤佳 高小茹 白凤 刘凯东[3] 郭涛[1] LI Hejia;GAO Xiaoru;BAI Feng;LIU Kaidong;GUO Tao(Department of Anesthesiology,Beijing Haidian Hospital(Haidian Section of Peking University Third Hospital),Beijing,100080 China;Department of Anesthesiology,Beijing Haidian Maternal and Child Health Hospital,Beijing,100080 China;Department of General Surgery,Beijing Haidian Hospital(Haidian Section of Peking University Third Hospital),Beijing,100080 China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)麻醉科,北京100080 [2]北京市海淀妇幼保健院麻醉科,北京100080 [3]北京市海淀医院(北京大学第三医院海淀院区)普通外科,北京100080

出　　处：《中外医疗》2023年第34期22-26,共5页China & Foreign Medical Treatment

摘　　要：目的 比较腹腔镜结肠癌根治术术后镇痛中切口局麻药浸润与肋缘下腹横肌平面阻滞的效果。方法回顾性选取2020年2月—2023年2月北京市海淀医院收治的100例腹腔镜结肠癌根治术患者的临床资料,依据术后镇痛方法分为肋缘下腹横肌平面阻滞组(腹横肌平面阻滞组)、切口局麻药浸润组,各50例。统计分析两组围术期指标、静息和咳嗽时疼痛程度、静脉自控镇痛(patient controlled intravenous analgesia, PCIA)按压次数、生命体征、镇痛不全发生情况、不良反应发生情况。结果 腹横肌平面阻滞组瑞芬太尼用量、补救性镇痛药次数、术中输液量、术中出血量均少于切口局麻药浸润组,差异有统计学意义(P<0.05);麻醉苏醒时间、拔管时间、胃肠动力恢复时间、初次饮水时间、初次进食时间、初次肛门排气时间、下床时间、住院时间均短于切口局麻药浸润组,差异有统计学意义(P<0.05)。腹横肌平面阻滞组患者的静息和咳嗽时视觉模拟评分法评分均低于切口局麻药浸润组,差异有统计学意义(P<0.05);腹横肌平面阻滞组患者的自控镇痛按压次数均少于切口局麻药浸润组,差异有统计学意义(P<0.05);T2、T3、T4时腹横肌平面阻滞组患者的心率、平均动脉压均低于切口局麻药浸润组,差异有统计学意义(P<0.05)。腹横肌平面阻滞组患者的镇痛不全发生率为4.00%(2/50)低于切口局麻药浸润组的24.00%(12/50),差异有统计学意义(χ^(2)=8.306,P<0.05)。腹横肌平面阻滞组患者的不良反应发生率低于切口局麻药浸润组,差异有统计学意义(P<0.05)。结论 腹腔镜结肠癌根治术术后镇痛中肋缘下腹横肌平面阻滞的效果较切口局麻药浸润好。Objective To compare the effects of incisional local anesthetic infiltration and subcostal transversus ab-dominis plane block in postoperative analgesia of laparoscopic radical surgery for colon cancer.Methods The clinical data of 100 cases of patients undergoing laparoscopic radical surgery for colon cancer in Beijing Haidian Hospital from February 2020 to February 2023 were retrospectively selected,and were divided into subcostal transversus abdominis plane block group(transversus abdominis muscle plane block group)and incisional local anesthetic infiltration group based on postoperative analgesia methods,with 50 cases in each group.The perioperative indexes,pain level at rest and coughing,number of presses of patient controlled intravenous analgesia(PCIA),vital signs,incidence of incomplete analgesia,and incidence of adverse reactions were statistically analyzed in the two groups.Results The dosage of remifentanil and the number of remedial analgesics and the amount of intraoperative fluids and the amount of intraoperative bleeding in patients in the transversus abdominis plane block group were less than those in the inci-sion local anesthetic infiltration group,and the differences were statistically significant(P<0.05),and the time of awak-ening from anesthesia extraction time,gastrointestinal power recovery time,first drinking time,first eating time,first anal exhaustion time,and time to get out of bed and hospital stay were shorter than those of incision local anesthetic infiltration group,and the differences were statistically significant(P<0.05).The visual analog scale scores at rest and during coughing of patients in the transversus abdominis plane block group were lower than those in the incision local anesthetic infiltration group,and the differences were statistically significant(P<0.05).The number of PCIA presses in patients in the transversus abdominis plane block group were all less than those in the incision local anesthetic infiltration groupand,and the difference was statistically significant(P<

关 键 词：腹腔镜结肠癌根治术 切口局麻药浸润 肋缘下腹横肌平面阻滞 镇痛不全 

分 类 号：R4[医药卫生—临床医学]