超声引导下TAP阻滞对宫颈癌根治术患者术后镇痛效果的影响

Analgesic efficacy of ultrasound-guided transversus abdominis plane block after radical surgery of cervical cancer

目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞用于宫颈癌根治手术后的镇痛效果。方法 50例全麻下行宫颈癌根治术患者,随机分为术后腹横肌平面阻滞(TABP)+患者自控静脉镇痛(PCIA)(研究组)及单纯PCIA组(对照组),每组各25例,术后均使用静脉自控镇痛泵。分别记录两组患者术后清醒拔管即刻、2、6、12和24小时的VAS及Ramsay评分;第1次需求PCA距离清醒拔管的时间、术后24小时镇痛泵药物使用量及术后24小时镇痛泵按压次数;术后不良反应发生情况。结果研究组患者术后各时间点VAS评分均低于对照组(P<0.01),Ramsay镇静评分在T0和T1时点均高于对照组(P<0.05)。研究组患者第1次需求PCA距离清醒拔管的时间明显长于对照组(P<0.01);术后24小时镇痛泵药物使用量及按压次数明显少于对照组(P<0.01);术后镇痛的恶心呕吐发生率明显低于对照组(P<0.05)。结论超声引导下TAP阻滞用于经腹宫颈癌根治术能明显减少术后镇痛药的需要量及副反应,增加镇痛效果。

Objective To observe the effects of ultrasound-guided transverse abdominis plane （TAP）block on postoperative analgesic efficacy in patients undergoing radical surgery of cervical cancer. Methods 50 patients undergoing radical surgery of cervical cancer under generall anesthesia, were randomly divided into TABP＋PCIA group （Study Group） and PCIA group （control group）,25 in each group. Patient-controlled intravenous analgesia pump was used in all patients after operation. VAS scores of patients in two groups after immediate extubation,2h,6h,12h and 24h were recorded. The time from the first PCIA to extubation, postoperative 24h PCIA drug use and compressin numbers were recorded. The postoperative adverse reactions were recorded. Results VAS scores in the study group patients at each time point were lower than that in the control group （ P〈0.01）. The time of study groups during extubation and the first PCA was longer than that of the control group （ P〈0.01）. The postoperative 24h PCIA drug use and compressin numbers in the control group were significantly less than in the control group （ P〈0.01）. The incidence of nausea and vomiting during postoperative analgesia in the study group was significantly lower than in the control group （ P〈0.05）. Conclusion Ultrasound-guided TAP block reduces postoperative sufentanil consump-tion and improves the efficacy of postoperative analgesia in patient undergoing radical surgery of cervical cancer.