超声引导下腹横肌平面阻滞在腹腔镜妇科手术后镇痛中的应用

Application of ultrasound-guided transversus abdominis plane block in postoperative analgesia for laparoscopic gynecological surgery

目的将超声引导下腹横肌平面阻滞应用于腹腔镜妇科良性疾病手术病例的术后镇痛,探讨其临床价值。方法选取2017年1月-2019年1月青海交通医院妇产科实施腹腔镜手术的妇科良性疾病病例,研究组(n=60)病例术后采用腹横肌平面阻滞+病人自控镇痛(patient?controlled analgesia,PCA)方法,对照组(n=60)仅采用PCA镇痛方法。分析两组术后疼痛管理和康复效果及指标。结果研究组平均年龄(43.9±6.7)岁、对照组平均年龄(45.6±8.0)岁,两组ASA分级构成比、手术麻醉持续时间、手术方式构成比差异均无统计学意义(P>0.05)。两组术后各时间点VAS评分差异大多无统计学意义;研究组术后多个时间点的舒芬太尼用量少于对照组(P均<0.05)。研究组术后首次使用PCA平均时间[(172.7±83.2)min vs(47.5±26.9)min,P<0.05]、追加额外镇痛剂比例(11.7%vs 43.3%,P=0.000)、术后恶心和呕吐发生率(8.3%vs 23.3%,P=0.024),下地活动时间[(23.2±6.7)h vs(29.1±8.5)h,P=0.000]和平均住院时间[(5.7±2.1)d vs(7.0±2.4)d,P=0.000]均优于对照组。结论超声引导下腹横肌平面阻滞减少了腹腔镜妇科良性疾病患者术后阿片类药物用量,加快了患者康复进程。

Objective To investigate the clinical value of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients with gynecological benign diseases undergoing laparoscopic surgery.Methods Patients with benign gynecological diseases received laparoscopic surgery from January 2017 to January 2019 in Qinghai Communications Hospital were included in this study.The study group(n=60)received transversus abdominis plane block+PCA analgesia after operation,while the control group(n=60)used PCA analgesia alone.The general information,pain management and rehabilitation indicators of the two groups were analyzed.Results The average age of the study group was(43.9±6.7)years and it was(45.6±8.0)years in the control group.There was no significant difference in ASA grading,duration of anesthesia,operation mode between the two groups(all P>0.05).There was little difference in postoperative VAS score between the two groups.The dosage of sufentanil in the study group was less than that in the control group at 12 h and 24 h(P<0.05,respectively).The study group was superior to the control group in terms of the mean time to first analgesic use[(172.7±83.2)min vs(47.5±26.9)min],the percentage of additional analgesics use(11.7%vs43.3%),the incidence of PONV(8.3%vs 23.3%),the time of mobility[(23.2±6.7)h vs(29.1±8.5)h]and the average length of hospital stay[(5.7±2.1)d vs(7.0±2.4)d](all P<0.05).Conclusion Ultrasound-guided transversus abdominis plane block reduces the amount of opioids used after laparoscopic surgery for benign gynecological diseases and accelerate the recovery process.