超声引导下腹横肌平面神经阻滞复合患者自控镇痛用于妇科开腹手术术后镇痛的临床研究

Clinical research about the effect of ultrasound-guided transversus abdominis plane nerve block with PCIA for laparotomy of gynecology

目的观察超声引导下腹横肌平面(transversus abdominis plane,TAP)神经阻滞复合患者自控镇痛用于妇科开腹手术术后镇痛的效果。方法选择清华大学附属北京清华长庚医院40例全麻下行妇科开腹手术的患者,随机分为A、B两组,A组为TAP复合患者自控镇痛(patient-controlled intravenous analgesia,PCIA)组,B组为单纯PCIA组,每组20例。术后A组在超声引导下用0.25%的罗哌卡因15 ml行双侧TAP神经阻滞,2组均给予PCIA,记录术后4、8、12、24、30 h内的视觉模拟评分(VAS)和舒适程度评分(BCS),并观察记录2组患者的不良反应。结果术后4、8、12、24 h时,A组的疼痛评分均低于B组(P<0.05);术后30 h,2组疼痛评分差异无统计学意义(P>0.05),同时A组的BCS舒适度评分均高于B组(P<0.05)。结论超声引导下行TAP神经阻滞能在术后24 h内安全有效地用于妇科开腹手术的术后镇痛,值得在临床上推广应用。

Objective To observe the effect of ultrasound-guided transversus abdominis plane （TAP） nerve block with PCIA for laparotomy of gynecology. Methods A total of 40 patients who underwent laparotomy of gynecology in Beijing Tsinghua Changgung Hospital, was randomly divided into A and B group （group A： TAP with PCIA, group B： PCIA）. Each group had 20 cases. After surgery, two groups were given PCIA, while group A received ultrasound-guided bilateral TAP nerve block with 0.25% ropivacaine 15 ml. The VAS pain score and BCS score at 4 h, 8 h, 12 h, 24 h and 30 h after operation, and the adverse reactions of patients were observed in each group. Results The pain scores of group A were lower than those of group B （P 〈 0.05） after operations at 4 h, 8 h, 12 h, 24 h respectively, while there was no statistical difference between the two groups at 30 h after operation. BCS scores of group A were higher than those of group B （P 〈 0.05）. Conclusion Ultrasound-guided TAP block could be used safely and effectively for postoperative analgesia of laparotomy of gynecology during 24 h after operations. It is worthy popularizing in clinic.