腹腔镜直肠癌术中应用腹横筋膜阻滞与镇痛泵的效果对比

Comparative study of the transversus abdominis plane block and patient-controlled intravenous analgesia in laparoscopic radical resection of rectal cancer

目的:比较腹横肌平面(transversus abdominis plane,TAP)阻滞与患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)在腹腔镜辅助直肠癌根治骶前吻合术后的镇痛效果。方法:连续选取42例行腹腔镜辅助直肠癌根治骶前吻合术的患者,随机分为TAP组与PCIA组,每组21例。记录两组年龄、性别、手术方式、手术时间、术中出血量、术后肿瘤分期、术后近期并发症(14 d内)、首次下床时间、首次排气时间及不同时间点的疼痛评分。结果:两组患者年龄、性别、肿瘤分期、手术时间、术中出血量、术后并发症、首次下床时间差异无统计学意义; TAP组术后首次排气时间[(50.0±12.7) h vs.(60.2±13.3) h]优于PCIA组。两因素重复测量方差分析显示,TAP组疼痛评分较PCIA组低0.444(95%CI:-0.816～-0.73,P<0.05)。结论:腹腔镜辅助直肠癌根治骶前吻合术中采用TAP阻滞具有较好的镇痛作用,与PCIA相比减少了对肠道的抑制作用,加速了患者的恢复。

Objective：To compare the different roles between transversus abdominis plane （TAP） block and patient-controlled intravenous analgesia （PCIA） in postoperative analgesia and recovery aher laparoscopic rectal cancer surgery.Methods：A total of 42 patients, who underwent laparoscopic-assisted radical resection and anterior sacral anastomosis for rectal cancer,were randomly divided into TAP group （ n = 21 ） and PC IA group （ n = 21 ）. Gender, age, operation mode, operation time, intraoperative bleeding, postoperative tumor stage, postoperative complications （within 14 d） ,postoperative ambulation time, postoperative exhaust time and postoperative pain score at different time points were recorded. Results： There were no statistical differences hetween two groups in gender, age, tumor stage, operation time,intraoperative blood loss,postoperative complications and first ambulation time.However, the first exhaust time of the TAP group was significantly better than that of PCIA group [ （50.0± 12.7）h vs. （60.2± 13.3）h,P〈0.05 ] ）.Two-lEctor repeated analysis of variance showed that the difference of pain score was 0.444,TAP group was lower than PCIA group （95% CI：-0.816- -0.73, P〈0.0S）.Conclusions：Compared with PCIA in laparoscopic radical resection of rectal cancer, the TAP block has better analgesic effect, which reduces the intestinal inhibition and accelerates the recovery of patients.