肋缘下TAPB联合单侧腹直肌鞘阻滞对腹腔镜胆囊切除术患者应激及苏醒质量的影响  

Impact of subcostal TAPB combined with unilateral rectus sheath block on stress and recovery quality in patients undergoing laparoscopic cholecystectomy

作　　者：张敏 张富杰 谭会领 崔同阳 武振东 吕吟啸 ZHANG Min;ZHANG Fu-jie;TAN Hui-ling;CUI Tong-yang;WU Zhen-dong;LYU Yin-xiao(Department of Anesthesiology,Hebei Petro China Central Hospital,Hebei Province,Langfang 065000,China)

机构地区：[1]河北中石油中心医院麻醉科,河北廊坊065000

出　　处：《河北医科大学学报》2024年第8期879-884,共6页Journal of Hebei Medical University

基　　金：廊坊市科学技术研究与发展计划项目(2021013149)。

摘　　要：目的探究肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAPB)联合单侧腹直肌鞘阻滞在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的应用,观察对患者炎症应激及苏醒期质量、舒适度影响。方法选取在我院进行腹腔镜胆囊切除术患者85例,随机数字表法对患者进行分组,对照组(n=42)患者给予TAPB,观察组(n=43)患者行肋缘下TAPB联合单侧腹直肌鞘阻滞,2组均进行全身麻醉,对2组术后炎症应激水平进行观察,记录患者苏醒期质量,并对其术后舒适度进行评估。结果2组术前C反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)、血糖比较差异无统计学意义(P>0.05),与术前比较,术后患者的各指标值均上升,但观察组各炎症应激因子水平均低于对照组,差异有统计学意义(P<0.05)。比较2组术后24 h的视觉模拟评分(visual analog scale,VAS),可知术后各个时间段观察组的VAS评分均低于对照组,差异有统计学意义(P<0.05)。2组手术时间、术中出血量及住院时间比较,处于相同水平,差异无统计学意义(P>0.05),但观察组术后首次排气时间、苏醒时间及术后下床活动时间均短于对照组,差异有统计学意义(P<0.05)。术后2组BCS比较,观察组高于对照组,差异有统计学意义(P<0.05)。观察组患者出现各种不良反应症状的频率低于对照组,总不良反应发生率为18.60%,低于对照组(40.48%),差异有统计学意义(P<0.05)。结论LC术中应用肋缘下TAPB联合单侧腹直肌鞘阻滞可以提高患者术后舒适度及苏醒期质量,降低患者的炎症应激反应,具有临床应用价值。Objective To explore the application of transversus abdominis plane block(TAPB)combined with unilateral rectus sheath block(RSB)in laparoscopic cholecystectomy(LC)and to observe the effects on inflammatory stress and quality and comfort during the recovery period.Methods In total,85 patients who underwent LC in our hospital were selected and grouped.The control group(n=42)was given TAPB,and the observation group(n=43)was given subcostal TAPB combined with unilateral RSB;both groups were given general anesthesia.The postoperative inflammatory stress level was observed in the two groups,the quality of the patients during the recovery period was recorded,and the postoperative comfort was evaluated.Results There was no significant difference in preoperative C-reactive protein(CRP),interleukin-6(IL-6),and blood glucose levels between the two groups(P>0.05).Compared with those before surgery,the values of the postoperative patients increased significantly,but the levels of inflammatory stress factors in the observation group were lower than that of the control group,showing significant differences(P<0.05).Comparion of the visual analogue scale(VAS)scores at 24 h after surgery showed that the VAS scores of the patients in the observation group were lower than that of the control group at different periods after surgery,and there were significant differences between the two groups(P<0.05).The duration of operation,intraoperative blood loss and length of hospital stay of the two groups were not significantly different(P>0.05),while the first time of postoperative anal exhaust,awakening time and the time of first off-bed activity in the observation group were shorter than those of the control group,and the difference was statistically significant(P<0.05).After surgery,Braden Comfort Scale(BCS)scores were higher the observation group than in the control group,and the difference was significant(P<0.05).The frequency of patients in the observation group was lower than that of the control group,and the total adverse effect rat

关 键 词：胆囊切除术 腹腔镜 肋缘下腹横肌平面阻滞 单侧腹直肌鞘阻滞 

分 类 号：R657.4[医药卫生—外科学]