超声引导下腹横肌平面阻滞联合羟考酮在日间腹腔镜胆囊切除术中的应用

Application of ultrasound guided transvers abdominis plane combined with oxycodone in laparoscopic cholecystectomy day surgery

目的观察超声引导下腹横肌平面（TAP）阻滞联合羟考酮对日间腹腔镜胆囊切除术的镇痛效果。方法选择择期行日间腹腔镜下胆囊切除术患者72例,男38例,女34例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为四组,每组18例。OL组：术前超声引导下脐上水平双侧TAP内分别注射生理盐水20ml;关腹时,给予羟考酮0.05mg/kg（生理盐水稀释至2ml）。OH组：术前超声引导下脐上水平双侧TAP内分别注射生理盐水20ml;关腹时,给予羟考酮0.2mg/kg（生理盐水稀释至2ml）。OL＋TAP组：术前超声引导下脐上水平双侧TAP内分别注射0.375%罗哌卡因20ml＋地塞米松5mg;关腹时,给予羟考酮0.05mg/kg（生理盐水稀释至2ml）。NS组：术前超声引导下脐上水平双侧TAP内分别注射生理盐水20ml;关腹时,给予生理盐水2ml。记录患者苏醒时间,拔管后即刻（T0）、术后2h（T1）、4h（T2）、12h（T3）、24h（T4）的VAS评分、追加羟考酮的总量及次数。记录患者嗜睡、头痛、恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应的发生情况。结果 T1、T2时OL组,T0~T3时OH组及OL＋TAP组VAS评分明显低于NS组（P〈0.01）,T4时OL＋TAP组VAS评分明显低于NS组（P〈0.05）。T0~T3时OH组及OL＋TAP组VAS评分明显低于OL组（P〈0.01）。T3时OL＋TAP组VAS评分明显低于OH组（P〈0.01）。OL组追加羟考酮总量和次数明显多于其它三组（P〈0.01）。OH组苏醒时间明显长于其它三组（P〈0.01）。四组患者术后嗜睡、头痛、恶心呕吐发生率差异无统计学意义,均未发生呼吸抑制或皮肤瘙痒。结论超声引导下腹横肌平面阻滞联合羟考酮0.5mg/kg能较好地满足日间腹腔镜胆囊切除术的镇痛要求,且不影响患者的苏醒时间及各种不良反应的发生率。

Objective To investigate the analgesia effect of ultrasound guided transverse abdominis plane（TAP）block combined with oxycodone after laparoscopic cholecystectomy day surgery.Methods Seventy-two ASA Ⅰ orⅡ patients（38 males,34 females,aged 18-65years）were randomized into four groups：oxycodone 0.05 mg/kg group（group OL）,oxycodone 0.2 mg/kg group（group OH）,ultrasound guided TAP block combined with oxycodone 0.05mg/kg group（group OL＋TAP）and NS control group（group NS）.The VAS scores were evaluated immediately after extubating,operative 2h（T1）,4h（T2）,12h（T3）,24h（T4）.The duration of recovery from anesthesia,the additional oxycodone requirement and the incidence of adverse events（drowsiness,headache,nausea and vomiting,respiratory depression,and itching）were recorded.Results Compared with group NS,the VAS scores in group OL at T1,T2 and the VAS scores in group OH and group OL＋TAP at T0-T3 were significantly decreased（P〈0.01）,as well as in group OL＋TAP at T4（P〈0.05）,respectively.Compared with group OL,the VAS scores in both group OH and group OL＋TAP were significantly decreased at T0-T3（P〈0.01）.The VAS scores were lower in group OL＋TAP than that in group OH at T3（P〈0.01）.Group NS required more additional oxycodone than the other three groups,and group OL required more extra amount of oxycodone than group OH and group OL＋TAP（P〈0.01）.The duration of recovery from anesthesia in group OH was increased（P〈0.01）.There was no significant difference of adverse events between four groups.Conclusion Ultrasound guided TAP block combined with oxycodone 0.5mg/kg can provide adequate pain relief with no impact on duration of recovery and adverse events.