超声引导下腹横肌平面阻滞在结直肠癌根治术后镇痛的应用

The application of postoperative analgesia of ultrasound-guided transversus abdominis plane block in radical resection of colorectal cancer

目的观察超声引导下腹横肌平面(TAP)阻滞在结直肠癌根治术患者术后镇痛中的应用效果。方法选择我院近两年全麻下行结直肠癌根治术患者50例,按照随机数字表法分为两组,每组各25例。A组手术结束后拔管前在超声引导下双侧TAP分别注射0.45%甲磺酸罗哌卡因20 mL,B组双侧TAP阻滞注射等量生理盐水。所有患者术后均使用舒芬太尼静脉自控镇痛泵。观察两组术后2、4、8、12、24 h的疼痛视觉模拟评分(VAS),记录术后24 h内舒芬太尼用量,镇痛泵的按压次数,患者镇痛满意度及不良反应。结果术后2、4、8、12和24 h A组VAS评分分别为(1.08±0.86)、(1.60±0.71)、(1.92±0.49)、(2.28±0.61)、(2.44±0.51),均低于B组(1.88±0.73)、(2.24±0.72)、(2.68±0.56)、(2.96±0.54)和(3.24±0.44);舒芬太尼用量A组(53.20±1.39)μg,B组(59.18±2.82)μg;镇痛泵按压次数A组(10.40±2.78)次,B组(22.36±5.63)次;患者镇痛满意度A组(9.12±0.78),B组(7.52±0.77);恶心呕吐情况比较A组2例,B组8例;上述各项指标差异除术后4hVAS评分外均有统计学意义,两组患者均无呼吸抑制出现。结论超声引导下腹横肌平面阻滞用于结直肠癌根治术患者的术后镇痛可以减少术后静脉镇痛药的使用量,降低阿片药物引起的不良反应发生率,并使镇痛效果更加完善,其定位准确,操作方便,损伤较小,安全性高,适合临床应用。

Objective To observe the application effects of postoperative analgesia of ultrasound - guided transversus abdominis plane（ TAP） block in radical resection of colorectal cancer patients. Methods Fifty patients undergoing radical resection of colorectal cancer in our hospital within nearly two years were divided into two groups,according to number table mehtod,25 cases in each group. Patients of group A were injected with 0.45% ropivacaine mesylate 20 mL in ultrasound - guided bilateral TAP after the end of surgery before extuba- tion ; the patients of group B were injected with the same amount of normal saline in ultrasound - guided bilateral TAP block, Postoperative patient - controlled intravenous analgesia with sufentanil was provided to all patients. The VAS score of two groups after operation record the postoperative dosage of sufentanil in 24h,pressing times of analgesia pump,the satisfaction of patients with postoperative analgesia and adverse reactions. Results The VAS score of group A（ 1.08 ±0. 86） , （1.60 ± 0. 71）, （1. 92 ± 0. 49）, （2. 28 ± 0. 61 ） , （2. 44 ± 0. 51） were lower than that of group B（ 1.88 ±0.73） ,（2.24 ±0.72）, （2. 68 ±0.56）,（ 2. 96 ± 0 .5 4 ）,（ 3. 24 ± 0 .4 4 ） . The dos- age of sufentanil in group A （ 53. 20 ± 1. 39 ） μg vs. group B （ 59. 18 ± 2. 82 ） μg,pressing times of analgesia pump,group A（ 10.40 ±2.78）vs. group B （2 2 .3 6± 5 .6 3 ）, the satisfaclion of palients with postoperalive analge- sia,group A（9. 12 ±0. 78）vs. group B（7. 52 ±0. 77） . There were 2 cases of postoperative nausea and vomiting in group B vs 8 cases in group A, The above - mentioned indexes difference had statistical significance except postoperative 4h score. The indicators of respiratory depression in the two groups did not occur. Conclusion The application of postoperative analgesia of ultrasound - guided transversus abdominis plane（ TAP） block in radical resection of colorectal cancer patients,can reduce postoperative intravenous analgesic drug usage,decrease the in-cidence of adverse reactions induced by opioid drugs,and the analgesic effect is more effective with the positioning accuracy,convenient operation,less injury,high safety and suitable for clinical application.