超声引导下腹横肌平面阻滞对全身麻醉下腹腔镜胆囊切除术患者应激反应及镇痛效果的影响  

Effect of Ultrasound-guided Transversus Abdominis Plane Block on Stress Response and Analgesic Effect in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia

作　　者：屈添平 严俨 曹辉 QU Tianping;YAN Yan;CAO Hui(Department of Anesthesiology,Wuhu Hospital of Traditional Chinese Medicine,Wuhu,Anhui 241000,China)

机构地区：[1]芜湖市中医医院麻醉科,安徽芜湖241000

出　　处：《临床误诊误治》2023年第10期117-121,共5页Clinical Misdiagnosis & Mistherapy

基　　金：安徽省重点研究与开发计划(1704f0804038)。

摘　　要：目的探讨超声引导下腹横肌平面阻滞(TAPB)对全身麻醉下腹腔镜胆囊切除术患者应激反应及镇痛效果的影响。方法选取2022年5—10月收治的行腹腔镜胆囊切除术60例,根据麻醉方法不同将其分为观察组和对照组2组各30例。观察组在全身麻醉基础上给予超声引导下TAPB,对照组给予全身麻醉。比较2组麻醉前和术后6、12、24 h促肾上腺皮质激素(ACTH)和皮质醇(Cor),术后6、12、24和48 h视觉模拟评分法(VAS)评分,术后自主呼吸恢复时间、苏醒时间、拔管时间和术中舒芬太尼用量,以及术后48 h不良反应发生情况。结果术后6、12、24 h,2组ATCH和Cor均较麻醉前升高,但观察组ATCH和Cor低于对照组(P<0.05)。术后6、12和24 h,观察组VAS评分低于对照组(P<0.05)。观察组术后自主呼吸恢复时间、苏醒时间、拔管时间和术中舒芬太尼用量均短于或少于对照组(P<0.01)。术后48 h,观察组不良反应发生率(3/30,10.00%)低于对照组(10/30,33.00%)(P<0.05)。结论全身麻醉下腹腔镜胆囊切除术患者采用超声引导下TAPB镇痛效果明显,可减轻应激反应,改善术后苏醒相关指标,且不良反应少。Objective To investigate the effects of ultrasound-guided transversus abdominis plane block(TAPB)on stress response and analgesia in patients undergoing laparoscopic cholecystectomy under general anesthesia.Methods Sixty patients undergoing laparoscopic cholecystectomy admitted to our hospital from May 2022 to October 2022 were selected.According to different anesthesia methods,they were divided into observation group and control group,with 30 cases in each group.The observation group was given ultrasound-guided TAPB on the basis of general anesthesia,and the control group was given general anesthesia.Adrenocorticotropin(ACTH)and cortisol(Cor)before anesthesia and at 6,12,and 24 h after anesthesia,visual analogue scale(VAS)scores at 6,12,24 and 48 h after anesthesia,spontaneous respiratory recovery time,recovery time,extubation time,intraoperative sufentanil dosage,and the occurrence of adverse reactions at 48 h after operation were compared between the two groups.Results At 6,12 and 24 h after operation,ATCH and Cor in the two groups were higher than those before anesthesia,but ATCH and Cor in observation group were lower than those in control group(P<0.05).The VAS scores of the observation group were lower than those of the control group at 6,12 and 24 h after operation(P<0.05).After operation,the recovery time of spontaneous respiration,recovery time,extubation time and intraoperative sufentanil dosage in the observation group were shorter or less than those in the control group(P<0.01).At 48 h after operation,the incidence of adverse reactions in the observation group(3/30,10.00%)was lower than that in the control group(10/30,33.00%)(P<0.05).Conclusion TAPB has obvious analgesic effect in patients undergoing laparoscopic cholecystectomy under general anesthesia,which can reduce stress response,improve postoperative recovery-related indexes,and have fewer adverse reactions.

关 键 词：胆囊切除术 腹腔镜 全身麻醉 超声引导 腹横肌平面神经阻滞 促肾上腺皮质激素 皮质醇 视觉模拟评分法 不良反应 

分 类 号：R657.4[医药卫生—外科学]