超声引导腹横肌平面阻滞对卵巢癌根治术中七氟醚浓度的影响

Effect of ultrasound guided transversus abdominis plane block on sevoflurane concentration in radical surgery for ovarian cancer

目的探讨卵巢癌根治术采用超声引导腹横肌平面阻滞的镇痛效果及对术中七氟醚浓度的影响。方法选取我院在2015年1月~2016年12月收治的48例行开腹卵巢癌根治术患者,按照随机数字表法分为TAP组和对照组,各24例,TAP组给予超声引导腹横肌平面麻醉阻滞,对照组不阻滞;观察两组患者手术指标(手术时间、术后拔管时间、苏醒时间及苏醒期躁动情况),术前、术中平均动脉压(MAP)、心率(HR),呼气末肺泡内七氟醚浓度(%),术后6、12、24、48h的VAS评分。结果 (1)TAP组患者在术后拔管时间、苏醒时间及苏醒期躁动情况明显低于对照组,差异有统计学意义(P<0.05);(2)TAP组患者术中MAP明显高于对照组,HR低于对照组,差异有统计学意义(P<0.05);(3)TAP组呼气末肺泡内七氟醚浓度为(1.88±0.29)%,对照组呼气末肺泡内七氟醚浓度为(3.51±0.49)%,差异有统计学意义(P<0.05);(4)TAP组术后6、12、24h VAS评分明显低于对照组,差异有统计学意义(P<0.05)。结论超声引导下TAP阻滞在卵巢癌根治术中能够有效降低七氟醚用量,缩短患者苏醒时间,提高镇痛效果,值得临床推广。

Objective To explore the analgesic effect of ultrasound guided transversus abdominis plane of ovarian cancer （TAP） in radical resection and its influence on sevoflurane concentration. Methods 48 cases of laparotomy radical ovarian cancer treated in our hospital from January 2015 to December 2016 were selected,and they were randomly divided into TAP group and control group,24 cases each group.Patients in TAP group were given ultrasound guided transversus abdominis plane block anesthesia,while the control group were not given ultrasound guided transversus abdominis plane block anesthesia.Operation index （operation time,postoperative extubation time,recovery time and restlessness）,preoperative mean arterial pressure （MAP）,heart rate （HR）,end expiratory alveolar concentration of sevoflurane（%）,VAS score of 6,12,24,48h after the operation of patients in two groups were observed. Results （1） The extubation time,recovery time and recovery period of restlessness in TAP group were significantly lower than those in the control group,the difference was statistically significant （P 〈 0.05）;（2）The MAP in the TAP group was significantly higher than that in the control group,and HR was lower than that in the control group,the difference was statistically significant （P 〈 0.05）;（3）The concentration of sevoflurane at the end of breath was （1.88＋0.29）% in group TAP,while the concentration of sevoflurane in the breath end of the control group was （3.51＋0.49）%,the difference was statistically significant （P 〈 O.05）;（4）The VAS scores of 6,12,24h after the operation in TAP group were lower than those in control group,the difference was statistically significant （P 〈 0.05）. Conclusion Ultrasound guided TAP block in the radical resection of ovarian cancer can effectively reduce the dosage of sevoflurane,shorten the recovery time of patients,and improve the analgesic effect,it is worthy of clinical promotion.