影像设备引导下腹横肌平面阻滞对结肠手术患者镇痛效果的影响

Impact of ultrasound-guided transversus abdominis plane block on analgesic effects in patients receiving colon operation

目的:探讨超声引导下腹横肌平面阻滞(transv ersus abdominis plane block,TAPB)对结肠手术患者镇痛效果的影响.方法:选取2012-01/2014-12于温岭市东方医院接受择期结肠手术的80例患者为研究对象,随机分为观察组和对照组,每组40例.全部患者均在超声引导下进行TAPB,分别注入30 mL的0.25%罗哌卡因(观察组)或等量的生理盐水(对照组).比较两组患者术中的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和心率(heart rate,HR)的变化,术后1、2、6、12、24 h的Ramsay评分和视觉模拟量表(visual analogue scale,VAS)评分,术中、术后使用舒芬太尼进行补救的剂量,术后电子镇痛泵的按压次数,术后肠道康复指标以及不良反应发生率.结果:观察组在切皮后3 min、手术结束时的SBP、DBP、HR均显著低于对照组(P<0.05).观察组术后1、2、6、12、24 h的VAS评分均显著低于对照组(P<0.05).观察组术中、术后24 h内的舒芬太尼用量以及电子镇痛泵按压次数均显著低于对照组(P<0.05).观察组患者的术后首次排气时间、首次排便时间、进行普食时间、住院时间等术后肠道康复指标均显著少于对照组(P<0.05).观察组出现3例(7.5%)不良反应,包括2例恶心,1例呕吐,对照组出现10例(25.0%)不良反应,包括7例恶心,3例呕吐,所有患者均无呼吸抑制、尿潴留等严重不良反应.观察组的不良反应发生率显著低于对照组(P<0.05).结论:在结肠手术前进行过影像设备引导下TAPB减少了术中生命体征的波动,有效缓解了术后的疼痛感,促进了术后的康复,安全可靠,值得临床推广.

AIM： To assess the impact of imaging-guided transversus abdominis plane block （TAPB） on analgesic effects in patients receiving colon operation. METHODS： Ninety patients who received colon operation from January 2012 to December 2014 at our hospital were enrolled for the studyand randomly divided into an observation group and a control group, with 40 cases in each group. All cases received ultrasound- guided TAPB with 30 mL of 0.25% ropivacaine （observation group） or saline （control group）. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and heart rate （HR） changes during surgery, Ramsay scores and visual analogue scale （VAS） scores at 1, 2, 6, 12, and 24 h after surgery, sufentanil consumption during and after surgery, frequency of electronic analgesia pump use after surgery, intestinal rehabilitation index after surgery, and incidence of adverse reactions were compared between the two groups. RESULTS： SBP, DBP, and HR at 3 min after skin incision and at the end of surgery were significantly lower in the observation group than in the control group （P 〈 0.05）. VAS scores at 1, 2, 6, 12, and 24 h after surgery were significantly lower in the observation group than in the control group （P 〈 0.05）. Sufentanil consumption during surgery and in 24 h after surgery, and frequency of electronic analgesia pump use after surgery were significantly lower in the observation group than in the control group （P 〈 0.05）. The time to first exhaust, time to first defecation, time to resume a normal diet, and hospitalization time were significantly shorter in the observation group than in the control group （P 〈 0.05）. Three （7.5%） patients developed adverse reactions in the observation group, including 2 cases of nausea and 1 case of vomiting. Ten （25.0%） patients developed adverse reactions in the control group, including 7 cases ofnausea and 3 case of vomiting. No respiratory repression, urine retention urine or other serious adverse reactions occurred in either group. The incidence of adverse reactions in the observation group was significantly lower than that in the control group （P 〈 0.05）. CONCLUSION： Ultrasound-guided TAPB before colon surgery could reduce the fluctuation of vital signs, effectively relieve postoperative pain and promote postoperative recovery, without significant complications.