腹横肌平面阻滞用于腹部手术术后镇痛的临床研究

Clinical study of transversus abdominis plane block applied in the postoperative analgesia of abdominal surgery

目的研究腹横肌平面(TAP)阻滞用于腹部手术术后镇痛的临床效果。方法选取2015年1月~2017年4月我院收治的98例行腹部手术患者,将其根据随机数字表法分为两组,各49例。两组均行TAP阻滞,对照组予以生理盐水,实验组予以罗哌卡因。比较两组的疼痛程度(VAS评分)、镇静程度(Ramsay评分)、舒适度(BCS评分)、不良反应发生率、镇痛泵使用情况(24 h镇痛泵药物使用剂量、第1次需求镇痛泵距离清醒拔管时间、镇痛泵实际按压次数、镇痛泵有效按压次数、24 h按压有效率)。结果术后0.5、2、6、12、24 h时,实验组的VAS评分低于对照组,Ramsay、BCS评分高于对照组,差异有统计学意义(P<0.05)。两组的不良反应总发生率差异无统计学意义(P>0.05)。实验组的24 h镇痛泵药物使用剂量、镇痛泵实际按压次数、镇痛泵有效按压次数均少于对照组,第1次需求镇痛泵距离清醒拔管时间长于对照组,24 h按压有效率高于对照组,差异有统计学意义(P<0.05)。结论 TAP阻滞可减轻腹部手术术后疼痛程度,提高舒适度及镇静效果,且具有较高的安全性。

Objective To study the clinical effect of transverse abdominal plane （TAP） block applied in the postopera- tive analgesia of abdominal surgery.Methods From January 2015 to April 2017,98 patients undergoing abdominal surgery admitted into our hospital were selectedand they were divided into the two groups according to the random number table method,and there were 49 patients in each group.TAP block was performed in both groups.The control group was given normal saline,and the experimental group was given Ropivacaine.The pain score （VAS score）,sedation degree （Ramsay score）,comfort degree （BCS score）,incidence rate of adverse reactions,and the useage of analgesic pump （drug use dose of 24 h analgesic pump,the duration from the first demand of analgesic pump to awakening and extubation,actual press times of analgesic pump,valid press times of analgesic pump,and the total effective rate of 24 h press） were compared between the two groups.Results After 0.5 h,2 h,6 h,12 h and 24 h,VAS score in the experimental group was lower than that in the control group,and Ramsay and BCS score were higher than those in the control group,and the difference was statistically significant （P〈0.05）.There was no statistical difference of the total incidence of adverse reactions between the two groups （P〉0.05）.The drug use dose of 24 h analgesic pump,actual press times of analgesic pump and valid press times of analgesic pump in the experimental group were fewer than those in the control group,the duration from the first demand of analgesic pump to awakening and extubation time in the experimental group was longer than that of the control group,and the total effective rate of 24 h press in the experimental group was higher than that in the control group,and the difference was statistically significant （P〈0.05）.Conclusion TAP block can reduce postoperative pain degree after abdominal surgery,improve the comfort degree and sedation effect,and has a higher safety.