超声引导腹横肌平面阻滞对于肝肿瘤患者术中和术后镇痛效果的影响

Effects of Ultrasound?guided Transverse Abdominis Plane Block on Intraoperative and Postoperative Analgesia in Patients Undergoing Liver Tumor Resection

目的观察腹横肌平面(TAP)阻滞用于成人肝肿瘤手术患者术中和术后的镇痛效果。方法 60例全麻下行开腹肝肿瘤切除术手术患者,随机均分为2组。麻醉诱导后1组行超声引导双侧TAP阻滞,注射0.2%罗哌卡因(1.5 mg/kg,R组),另一组行常规全身麻醉未行TAP阻滞(C组)。记录2组术中切皮前后血压、心率变化,舒芬太尼用量,术后2、6、12、24、48 h视觉模拟疼痛(VAS)评分观察术后镇痛满意度,同时记录不良反应的发生情况。结果与C组比较,R组切皮时血压、心率波动明显减小(P<0.05);2组患者术后2、6、12 h的VAS评分有明显差异,与C组比较,R组VAS明显降低(P<0.05),镇痛满意度较好(P<0.05),2组患者术后24 h及48 h VAS评分无明显差异;TAP阻滞后,R组术后哌替啶用量明显少于C组(P<0.05);2组均未见血肿、恶心、呕吐、皮肤瘙痒、胸闷等不良反应发生。结论超声引导下TAP阻滞用于肝肿瘤手术能有效镇痛,明显减少术中和术后镇痛药的需要量,增加镇痛效果。

Objective To observe the effects of ultrasound-guided transverse abdominis plane （TAP） block on intraoperative and postoperative analgesic effieacy in patients undergoing liver tumor resection. Methods Sixty, patienls scheduled for abdoMnal liver tumor reseetion under general anesthesia were randomly divided into 2 groups （ n =30 each ） ： ropivacaine group （ group R ） and matched group （ group C ）. After induc6on of anes- thesia, ultra.sound-guided bilaler＇al TAP block was perflormled and 0.2% ropivaeaine （ 1.5 mg/kg） was injected in group R, while nothing was done in group C. The hemodynamic parameters during skin incision were recorded. The eonsumption of sufentanil during operation and VAS seore at 2,6, 12,24 and 48 h aider operation and analgesic satisfaetion after operation were lecorded. The adverse reactions were also recorded. Results Compared with group C, haemodynmnie parameters in group R maintain even stable during skin incision （ P 〈 0.05 ） ; VAS at 2,6, 12 h after operation were sigificantly lower （ P 〈 0.05 ）, analgesic satisthetion was better.VAS at 24 and 48 h after operation were no significant different. There were no adverse tractions in both groups. Conclusion Uhrasound-gnided TAP block reduces intraoperative and postoperative sufentanil consumption and improves the efficacy of postoperative analgesia in patients undergoing liver tumor resection.