切口局麻药浸润和超声引导下腹横肌平面阻滞对腹腔镜胆囊切除患者术后恢复的影响

Effects of incisions local infiltration and ultrasound-guided transverse abdominis plane block on postoperative recovery in patients undergoing laparoscopic cholecystectomy

目的切口局麻药浸润和超声引导下腹横肌平面阻滞对腹腔镜胆囊切除患者术后恢复的影响。方法择期行腹腔镜下胆囊切除患者90例,年龄30~65岁,ASA I^III级。按照数字表法随机均分为3组:超声引导下腹横肌平面阻滞组(TAP组),0.5%罗哌卡因切口浸润组(ROP组),对照组(CON组)。记录3组患者手术时间、麻醉时间、术中瑞芬太尼、丙泊酚用量、术后镇痛药需求量、术毕至首次下床活动时间、住院时间与住院总费用等相关资料。结果TAP组与ROP组术后镇痛药需求量明显低于CON组(P<0.05);CON组术毕至首次下床活动时间明显长于TAP组和R组(P<0.05);CON组住院时间明显长于ROP组和TAP组(P<0.05);3组患者住院总费用差异无统计学意义(P>0.05)。TAP组与ROP组术后6 h VAS评分明显低于CON组。结论腹腔镜胆囊切除患者术后行超声引导下腹横肌平面阻滞与切口局麻药浸润麻醉有助于减少术后镇痛药需求量,缩短住院时间与首次下床活动时间,促进患者术后早期康复。

Objective To investigate the effects of incisions local infiltration and ultrasound-guided transverse abdominis plane block on postoperative recovery in patients receiving laparoscopic cholecystectomy.Methods 90 patients with American Society of Anesthesiologists(ASA)physical statusⅠ~Ⅲ,aged 30~65 years,and scheduled for elective laparoscopic cholecystectomy by using the numerical table method were randomly divided into three groups(n=30):ultrasound-guided transverse abdominis plane block group(TAP group),0.5%ropivacaine incisions infiltration group(ROP group)and control group(CON group).The operation time,anesthesia time,intraoperative dose of remifentanil and propofol,postoperative analgesic requirements,postoperative the leaving bed time,length of stay and the total hospitalization expenses in three groups were recorded.Results the postoperative analgesic requirements between TAP group and ROP group was much lower than CON group(P<0.05).Postoperative the leaving bed time in CON group was much longer than TAP group and R group(P<0.05).The length of stay in CON group was significantly longer than ROP group and TAP group(P<0.05).There was no significant difference in total hospitalization expenses among the three groups(P>0.05).Compared with CON group,the VAS scores in TAP group and ROP group was significantly lower at 6 hours after surgery.Conclusion:Patients with laparoscopic cholecystectomy receiving ultrasound-guided transverse abdominis plane block and incisions local infiltration can reduce postoperative analgesics requirements,shorten length of stay and the leaving bed time,and accelerate the early postoperative recovery.