TAP对腹腔镜子宫切除患者血浆皮质醇的影响

Effects of ultrasound-guided transversus abdominis plane block on serum cortisol of patients who suffered from hysterectomy under laparoscope

目的探讨超声引导腹横肌平面阻滞(TAP)对腹腔镜子宫切除患者血浆皮质醇和血流动力学影响。方法将80例择期手术的子宫肌瘤患者随机分为对照组(B组)及观察组(A组)各40例,两组患者均采用丙泊酚、芬太尼、维库溴铵施行麻醉诱导,丙泊酚、瑞芬太尼、维库溴铵维持麻醉。A组全麻插管后,再经超声引导腹横肌平面阻滞后接受腹腔镜手术,观察两组患者麻醉前(T0)、麻醉后60 min(T1)、拔管后5 min(T2)、术后2h(T3)、以及术后24 h(T4)的MAP、HR、血浆皮质醇(Cor)和VAS评分变化。结果与T0比较,两组患者T1时HR显著降低,T2时MAP、HR、Cor明显增高(P<0.05)。与A组比较,B组患者T3、T4时Cor明显增高(P<0.05),T3时MAP、VAS评分明显增高,镇痛泵按压次数和芬太尼用量组明显增多(P<0.05),差异有统计学意义。结论与单独使用全身麻醉相比,超声引导TAP可以为腹腔镜子宫切除患者提供更好的术中血浆皮质醇浓度和血流动力学控制,降低阿片类药物的需求和术后视觉模拟痛觉评分(VAS)。

Objective To investigate the effects of ultrasound -guided TAP block on serum cortisol of patients who receivedhysterectomy under laparoscopenethods 80 patients who suffered from hysteromyomawere randomly divided into control group （Group B） and observation group （Group A）, 40 in each group. Patients in both groups were induced to narcotism with propofol, fentanyl and vecuronium bromide, and maintain narcotism with propofol, remifentanil and vecuronium. After been anaesthetized, patients in Group A received ultrasound - guided TAP block after intubation. MAP, HR, plasma cortisol （Cor）and VAS scores were measured just before anesthesia （T0）, 60 minutes after anesthesia （ T1 ）, 5 minutes after extubation （ T2 ）, 2 and 24 hours after extubation （T3 and T4）. Results Compared with TO, HR of all patients were significantly decreasedat T1 while MAP, HR and Cor were increased at T2 （P 〈 0. 05）. Compared with Group A, Cor of patients in Group B were significantly increasedat I3 and T4 （P 〈 0. 05 ）. MAP, VAS, the number of pressing Analgesia and the dosage of fentanylin Group B were significantly increasedat T3 （P 〈 0. 05 ）. Conclusions Ultrasound - guided TAP block could decrease postoperative visual analogue scale （VAS） scores and the demand of opioid, provide better intraoperative hemodynamic control on serum cortisol of patients in taparoscopic hysterectomy surgery than general anesthesia alone.