超声引导下腹横肌平面阻滞在子宫切除术后镇痛中的应用

Application of postoperative analgesia of ultrasound guided transversus abdominis plane block in patients undergoing hysterectomy

目的 观察超声引导下腹横肌平面（TAP）阻滞在子宫切除术后镇痛中的应用效果.方法 选择全身麻醉下行子宫切除术患者50例,按照随机数字表法分为两组：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阻滞采用注射等量0.9%氯化钠注射液,每组25例.所有患者术后均使用苏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内苏芬太尼用量和术后镇痛泵的按压次数,以及患者术后镇痛满意度和不良反应发生情况.结果 术后2 h VAS评分A组（0.96±0.74）分比B组（1.88±0.73）分（t=4.45）;术后 4 h VAS评分A组（1.52±0.65）分比B组（2.24±0.72）分（t=3.69）;术后8 h VAS评分A组（1.88±0.44）分比B组（2.68±0.56）分（t=5.64）;术后12 h VAS评分A组（2.24±0.52）分比B组（2.96±0.54）分（t=4.80）;术后24 h VAS评分A组（2.44±0.51）分比B组（3.24±0.44）分（t=5.99）,差异均有统计学意义（均P=0.00）.术后24 h内苏芬太尼用量：A组（51.60±1.02）μg比B组（55.46±1.37）μg（t=11.30,P=0.00）;术后镇痛泵按压次数：A组（7.20±2.04）次比B组（14.92±2.74）次（t=11.30,P=0.00）;患者术后镇痛满意度：A组（9.20±0.71）分比B组（7.52±0.77）分（t=8.03,P=0.00）;术后恶心呕吐情况比较：A组2例,B组8例,差异有统计学意义（x2=4.50,P=0.03）.结论 超声引导下腹横肌平面阻滞用于子宫切除术患者的术后镇痛,有效缓解了患者术后24 h内的疼痛,减少了术后静脉镇痛药的用量,降低了药物引起的不良反应发生率,提高了患者的舒适度和满意度,适合临床应用.

Objective To observe the application effects of postoperative analgesia of ultrasound guided transverses abdominis plane （TAP） block in patients undergoing hysterectomy.Methods 50 patients with hysterectomy under general anesthesia were selected,and they were randomly divided into two groups according to the digital table,25 cases in each group.The patients of group A were injected with 0.45% ropivacaine mesylate 20mL in ultrasound guided bilateral TAP after the end of surgery before extubation,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 the two groups after operation,the postoperative dosage of sufentanil in 24h and pressing times of analgesia pump,and the satisfaction of patients with postoperative analgesia,and adverse reactions were observed.Results The VAS scores of 2h of group A （0.96±0.74）points vs.group B （1.88±0.73）points （t=4.45）;The VAS scores of 4h of group A （1.52±0.65）points vs.group B （2.24±0.72）points （t=3.69）;The VAS scores of 8h of group A （1.88±0.44）points vs.group B （2.68±0.56）points （t=5.64）;The VAS scores of 12h of group A （2.24±0.52）points vs.group B （2.96±0.54）points （t=4.80）;The VAS scores of 24h of group A （2.44±0.51）points vs.group B （3.24±0.44）points （t=5.99）;there were statistically significant differences（all P=0.00）.The postoperative dosage of sufentanil in 24h[group A （51.60±1.02）μg vs.group B （55.46±1.37）μg,t=11.30,P=0.00],the pressing times of analgesia pump[group A （7.20±2.04）times vs.group B （14.92±2.74）times,t=11.30,P=0.00],the satisfaction of patients with postoperative analgesia[group A （9.20±0.71）points vs.group B （7.52±0.77）points],t=8.03,P=0.00].There were 2 cases of postoperative nausea and vomiting in group B,and 8 cases in group A,the difference was statistically significant（x2=4.50,P=0.03）.Conclusion The application of postoperative analgesia of ultrasound guided TAP block in patients undergoing hysterectomy can reduce postoperative intravenous analgesic drug usage,reduce the incidence of adverse reactions induced by drugs,improve patients＇ comfort and satisfaction,it is suitable for clinical application.