超声引导腹横肌平面阻滞对全麻子宫切除术病人术后镇痛效果的影响

Effect of ultrasound-guided transverses abdominis plane block on efficacy of postoperative analgesia in pa- tients undergoing abdominal hysterectomy

目的探讨超声引导腹横肌平面（TAP）阻滞对全麻子宫切除术病人术后镇痛效果的影响。方法择期拟在全麻下行经腹子宫切除术病人60例，ASA分级Ⅰ或Ⅱ级，随机分为2组（n=30）：罗哌卡因组（R组）和生理盐水组（NS组）。麻醉诱导后行超声引导双侧TAP阻滞，分别注射0．375％罗哌卡因40ml（R组）或等容量生理盐水（NS组）。术后均行PCIA，维持VAS评分≤3分。于术后2、6、8、12、24h时行Ramsay镇静评分及BCS舒适度评分。记录术后血液动力学变化情况。记录舒芬太尼术中、术后24h内PCIA中的用量及术后24h内PCIA的有效按压次数（D1）和实际按压次数（D1），并计算D1／D2；记录不良反应的发生情况。结果两组术后SP、DP、HR、SpO，和RR均在正常范围，组间比较差异无统计学意义（P〉0．05）。与NS组比较，R组BCS舒适度评分升高，舒芬太尼术中及术后24h内PCIA用量减少，D1／D2升高（P〈0．05），Ramsay镇静评分差异无统计学意义（P〉0．05）。两组均未见血肿、恶心、呕吐、皮肤瘙痒、胸闷等不良反应发生。结论超声引导TAP阻滞减少了全麻子宫切除术病人围术期阿片类镇痛药用量，增强了术后镇痛效应。

Objective To investigate the effect of ultrasound-guided transverses abdominis plane （TAP） block on the efficacy of postoperative analgesia in patients undergoing abdoufinal hysterectomy. Methods Sixty ASA Ⅰ - Ⅱ patients scheduled for abdominal hysterectomy under general anesthesia were randomly divided into 2 groups （ n = 30 each） ： ropivacaine group （group R） and normal saline （group NS）. After induction of anesthesia, ultrasound-guided bilateral TAP block was performed, and 0. 375 vA ropivacaine 40 ml was injected in group R, while the equal volume of normal saline was used instead in group NS. The patients received patient-controlled intravenous analgesia （PCIA） with sufentanil after operation. The VAS score was maintained≤ 3, the level of sedation was evaluated with Ramsay sedation score, and the comfort level was evaluated with Bruggrmann comfort scale （BCS） score at 2, 6, 8, 12 and 24 h after operation. The hemodynamie parameters were recorded. The consumption of sufentanil during operation and within 24 h after operation, the number of successfully delivered doses （D1） and the number of attempts （D2 ） within 24 h after operation were recorded. D1/D2 was calculated. The adverse reactions were also recorded. Results SP, DP, HR, SpO2 and RR were in the normal range and there was no significant differences between the two groups （P 〉 0.05 ）. The consumption of sufentanil were significantly lower, while the BCS score and D,/D2 higher in group R than in group NS （ P 〈 0.05）. There were no adverse reactions in both groups. Conclusion Ultrasound-guided TAP block reduces the perioperative sufentanil consumption and enhances the efficacy of postoperative analgesia in patients undergoing abdominal hysterectomy.