超声引导下腹横肌平面阻滞用于腹腔镜袖状胃切除术病人疼痛抑制效果及对应激反应的影响  

Effect of ultrasound⁃guided transverse abdominal muscle plane block on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy

作　　者：肖月亮 徐建 姚洪林[1] 余得水[1] 何常佑 XIAO Yueliang;XU Jian;YAO Honglin;YU Deshui;HE Changyou(Department of Anesthesiology,The Second People’s Hospital of Yibin City,Sichuan Province,Yibin 644000,China)

机构地区：[1]四川省宜宾市第二人民医院麻醉科,644000

出　　处：《临床外科杂志》2023年第12期1218-1222,共5页Journal of Clinical Surgery

摘　　要：目的探讨超声引导下腹横肌平面阻滞(TAPB)用于腹腔镜胃袖状切除术(LSG)病人疼痛抑制效果及对应激反应的影响。方法2021年3月~2022年10月期间收治的行LSG病人98例,采用双盲法随机将其分为对照组49例,观察组49例。对照组行全身麻醉,观察组行TAPB+全身麻醉,比较两组病人术后疼痛、镇痛药物用量、应激水平、血流动力学及不良反应。结果观察组舒芬太尼、丙泊酚用量及术后48小时静脉镇痛泵有效按压次数分别为(232.38±29.62)μg、(328.40±40.68)mg和(5.60±1.25)次,对照组分别为(294.07±35.88)μg、(402.25±46.74)mg和(9.75±2.40)次,两组比较差异有统计学意义(P<0.05)。观察组术后各时间段视觉模拟量表(VAS)评分分别为(2.43±0.49)分、(2.29±0.46)分、(2.85±0.49)分、(2.41±0.39)分、(2.12±0.41)分、(1.82±0.32)分,对照组分别为(2.95±0.46)分、(3.22±0.51)分、(3.92±0.47)分、(3.13±0.65)分、(2.83±0.57)分、(2.05±0.53)分,两组比较差异有统计学意义(P<0.05)。观察组气管插管时(T2)、手术结束时(T3)、出麻醉苏醒室时(T4),平均动脉压分别为86.00(79.00,94.00)mmHg、87.00(80.00,90.00)mmHg、89.00(84.00,95.00)mmHg,心率分别为78.00(67.00,83.00)次/分钟、80.00(74.00,86.00)次/分钟、81.00(76.00,90.00)次/分钟,血氧饱和度分别为97.38(97.00,97.75)%、98.69(98.30,99.05)%、99.16(98.80,99.35)%;对照组平均动脉压分别为82.00(75.00,90.00)mmHg、85.00(77.00,93.00)mmHg、87.00(80.00,97.00)mmHg,心率分别为78.00(67.00,83.00)次/分钟、80.00(74.00,86.00)次/分钟、81.00(76.00,90.00)次/分钟,血氧饱和度分别为96.54(96.15,96.80)%、98.02(97.65,98.45)%、98.73(98.43,99.15)%,两组比较差异有统计学意义(P<0.05)。观察组术后6小时、24小时及48小时皮质醇分别为(192.47±40.25)ng/ml、(151.34±39.62)ng/ml、(118.69±30.57)ng/ml,C反应蛋白(CRP)分别为(25.24±6.29)mg/L、(20.93±5.83)mg/L、(13.61±4.29)mg/L,白细胞介素(IL⁃6)分别为(44.87±7.95)pg/L、(38.34±6Objective To investigate the effect of ultrasound⁃guided transverse abdominal plane block(TAPB)on pain inhibition and stress response in patients undergoing laparoscopic sleeve gastrectomy(LSG).Methods 98 cases of laparoscopic sleeve Gastrectomy patients admitted from March 2021 to October 2022 were selected as the research object,and they were randomly divided into control group(49 cases)and observation group(49 cases)by double blind method.The control group received general anesthesia,and the observation group received TAPB+general anesthesia.The postoperative pain,analgesic dosage,stress level,hemodynamics and adverse reactions of the two groups were compared.Results The dosage of sufentanil and propofol in the observation group,as well as the effective press frequency of the intravenous analgesia pump 48 hours after surgery[(232.38±29.62)μg,(328.40±40.68)mg and(5.60±1.25)],were lower than those in the control group[(294.07±35.88)μg,(402.25±46.74)mg and(9.75±2.40)](P<0.05).The visual analogue scale(VAS)scores for each time period of the observation group were(2.43±0.49),(2.29±0.46),(2.85±0.49),(2.41±0.39),(2.12±0.41)and(1.82±0.32),respectivly.While,the control group were(2.95±0.46),(3.22±0.51),(3.92±0.47),(3.13±0.65),(2.83±0.57)and(2.05±0.53),respectivly.The difference between the two groups was statistically significant(P<0.05).At the time of tracheal intubation(T2),at the end of operation(T3),and at the time of leaving the anesthesia recovery room(T4),the fluctuation range of mean arterial pressure[86.00(79.00,94.00)mmHg,87.00(80.00,90.00)mmHg and 89.00(84.00,95.00)mmHg vs 82.00(75.00,90.00)mmHg,85.00(77.00,93.00)mmHg and 87.00(80.00,97.00)mmHg],heart rate[78.00(67.00,83.00)times/min,80.00(74.00,86.00)times/min and 81.00(76.00,90.00)times/min vs 78.00(67.00,83.00)times/min,80.00(74.00,86.00)times/min and 81.00(76.00,90.00)times/min]and blood oxygen saturation[97.38(97.00,97.75)%,98.69(98.30,99.05)%and 99.16(98.80,99.35)%vs 96.54(96.15,96.80)%,98.02(97.65,98.45)%and 98.73(98.43,99.15)%]i

关 键 词：腹横肌平面阻滞 腹腔镜袖状胃切除术 应激反应 疼痛抑制 超声引导 

分 类 号：R614[医药卫生—麻醉学]