超声引导下腹横肌平面阻滞用于下腹部手术术后镇痛的效果

Clinical application of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients received lower abdominal surgery

目的：观察超声引导下腹横肌平面（TAP）阻滞用于下腹部手术术后镇痛的临床效果。方法选择下腹部手术患者90例，年龄25～55岁，随机分为三组，每组30例。A 组行超声引导下单侧 TAP 阻滞；B 组行舒芬太尼 PCIA；C 组行舒芬太尼＋罗哌卡因 PCEA。所有患者均在腰-硬联合麻醉下完成手术。观察并记录术后2、4、8、16、24 h 的 VAS 疼痛评分，及术后镇痛相关的不良反应。结果与 A 组比较，B 组在术后2、4、8、16 h 的 VAS 疼痛评分明显升高（P＜0.05）；C 组在术后24 h 的 VAS 疼痛评分明显降低（P＜0.05）。与 A 组比较，B 组恶心呕吐、皮肤瘙痒、嗜睡明显增多（P＜0.05）；C 组恶心呕吐、下肢感觉及运动异常、尿潴留明显增多（P＜0.05）。结论超声引导下腹横肌平面阻滞可有效缓解下腹部手术后24 h 内的疼痛，且无明显不良反应。

Objective To observe the postoperative analgesia effect of ultrasound-guided trans-versus abdominis plane block （TAP）in patients received lower abdominal surgery.Methods Ninety patients undergoing lower abdominal surgery were randomly divided into group A （received TAP）, group B （received patient controlled intravenous analgesia with sulfentanil）,and group C （received patient controlled epidural analgesia with sulfentanil and ropivacaine）for postoperative analgeda.All patients received combined spinal and epidural anesthesia.VAS score at postoperative 2,4,8,16 and 24 h,as well as the side effects related to postoperative analgesia,were observed and recorded for each patient.Results Comparing with group A,VAS scores of group B at postoperative 2,4,8,16 and 24 h were obviously higher （P〈 0.05）;Comparing with group A,VAS score of group C at post-operative 24 h was obviously lower （P〈 0.05）.Comparing with group A,nausea and vomiting,pru-ritus,and somnolence were more obvious in group B （P 〈 0.05）;nausea and vomiting,sensory and motor abnormality of lower limbs and urinary retention occurred more frequently in group C （P 〈0.05）.Conclusion Ultrasound-guided TAP can effectively relieve postoperative pain 24 hours,and has no obvious side effect in patients received lower abdominal surgery.