超声引导下神经阻滞对腹腔镜胆囊切除术患者预后影响的临床研究

The effect of ultrasound-guided nerve block on the prognosis of patients undergoing laparoscopic cholecystectomy

目的探讨超声引导下神经阻滞对腹腔镜胆囊切除术(LC)患者预后的影响。方法以在本院就诊拟择期行腹腔镜胆囊切除术的150例患者为研究对象,随机分为对照组与观察组各75例,对照组采用戳孔局部浸润镇痛,观察组使用超声引导下腹横肌平面阻滞(TAP)联合戳孔局部浸润镇痛。比较两组患者术后清醒时间、血流动力学变化、疼痛程度评分及镇痛药使用情况。结果观察组术后苏醒时间[(9.7±2.0)min]明显短于对照组[(23.9±2.4)min],术后追加镇痛药总剂量以及追加次数均明显低于对照组,差异均有统计学意义(P<0.05);观察组术后清醒时、术后6 h、术后24 h及术后48 h的视觉疼痛评分分别为0.99±0.22、1.05±0.14、1.13±0.23及1.40±0.38,明显低于对照组的3.99±0.36、3.67±0.43、3.39±0.38及3.93±0.20,差异均具有统计学意义(P<0.05);随着术后时间推移,术后48 h两组的视觉疼痛评分均高于术后24 h,差异具有统计学意义(P<0.05);两组不良反应发生率(36%vs 32%)差异无统计学意义(P>0.05)。结论超声引导下神经阻滞可明显降低患者术后疼痛,减少麻醉药的使用频次及使用剂量,显著改善患者术后转归且并不增加药物不良反应的发生率,值得临床参考借鉴。

Objective To investigate the effhect of ultrasound-guided nerve block on the prognosis of patients undergoing laparoscopic cholecystectomy. Methods A total of 150 cases undergoing elective laparoscopic cholecystectomy in our hospital was used as the research object, and randomly divided into control （ n = 75） and observation （ n = 75 ） groups. The control group used punctured local infiltration analgesia, and observation group used the transversus abdominis plane block （TAP） combined with local infiltration analgesia hole. The postoperative awake time, hemodynamic changes, pain score, and analgesic use were compared between two groups. Results The recovery time was significantly reduced in the observation group （9. 7 ±2） minutes compared to the control group （23.9 ± 2.4） minutes. The additional total dose of analgesics and average additional times were significantly lower in the observation group compared to the control group （ P 〈 0.05 ）. The pain score were O. 99±0. 22 after waking, 1.05 ±0. 14 at the postoperative 6 h, 1.13 ±0. 23 at the postoperative 24 h, and 1.40 ±0. 38 at the postoperative 48 h in the observation group, which was significantly lower than the corresponding 3.99 ± 0. 36, 3.67 ± 0. 43, 3.39± 0. 38, and 3.93 ±0. 20 in the control group （ P 〈 0. 05 ）. With the postoperative time, postoperative 48 h in two groups of visual pain scores were significantly higher than that of 24 h after the operation （ P 〈 0. 05 ）. The incidence of adverse reactions was no significant difference between observation group （36%） and control group （32%） （P 〉 0. 05 ）. Conclusions Ultrasound-gulded nerve block can obviously reduce postoperative pain, reduce drug use frequency and dosage, significantly improve postoperative outcomes, and does not increase the incidence of adverse drug reactions. It is worthy of clinical reference.