双侧腹横肌平面阻滞在腹腔镜食管裂孔疝修补术后快速康复中的应用

The application of bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair

目的探讨超声引导双侧腹横肌平面(transverses abdominis plane,TAP)阻滞在腹腔镜食管裂孔疝修补术后快速康复中的可行性和有效性。方法选取2014年10月至2015年10月,新疆维吾尔自治区人民医院择期行腹腔镜食管裂孔疝修补术患者60例随机分为三组:特耐组患者20例,术毕患者每8 h肌注特耐40 mg至24 h;TAP组患者20例,术毕即可行超声引导下双侧肋缘下TAP阻滞;特耐联合TAP组患者20例,术毕患者每8 h肌注特耐40 mg至24 h,并术毕即可行超声引导下双侧肋缘下TAP阻滞。超声引导下双侧TAP阻滞,每侧给予0.25%盐酸罗哌卡因40 ml。观察并记录三组患者术后2、4、6、8、12和24 h时静息视觉模拟(VAS)评分;记录患者对术后镇痛的满意度,有无局麻药中毒、恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应。结果特耐联合TAP组与其他两组比较,术后各时点VAS评分明显降低(P<0.05),患者术后镇痛满意度较高(P<0.05),无不良反应发生。结论特耐联合超声引导双侧肋缘下腹横肌平面阻滞在腹腔镜食管裂孔疝修补术后的镇痛效果确切,可有效促进患者快速康复,值得推广。

Objective To explore the feasibility and effectiveness of Ultrasound-guided bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair. Methods From October 2014 to October 2015,the patients in People＇ s Hospital of Xinjiang Uygur Autonomous Region undergoing selective laparoscopic hiatal hernia repair were randomly divided into 3 groups（ n = 20）. After the operation,Ultrasound-guided bilateral transverse abdominal plane block and intramuscular parecoxib were performed. According to the grouping situation,The patients of ultrasound-guided bilateral transverse abdominal plane block were administrated with 0. 25% ropivacaine hydrochloride 40 ml. The patients of intramuscular parecoxib were administrated 40 mg parecoxib every 8 to 24 hours. Visual analog pain score（ VAS） at 2,4,6,8,12 and 24 h after operation were compared. The satisfaction of postoperative analgesia and the adverse reactions such as local anesthetics poisoning,nausea and vomiting,respiratory depression and skin pruritus were compared. Results The VAS score of the TAP block group combined with parecoxib in all the time were Significantly lower than the other two groups,and The satisfaction of postoperative analgesia is higher（ P〈 0. 05）. No adverse reaction occurred. Conclusion Ultrasound-guided bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair combined with parecoxib had exact analgesic effect,could effectively promote the patients＇ rapid recovery,and were worth promoting.