羟考酮联合腹横肌平面阻滞对腹腔镜子宫切除手术患者术后应激反应的影响

Effect of oxycodone combined with transversus abdominis plane block on postoperative stress response in patients undergoing laparoscopic hysterectomy

目的研究羟考酮联合腹横肌平面阻滞(TAPB)对腹腔镜子宫切除手术患者术后镇痛及应激反应的影响。方法选择80例全麻下行腹腔镜子宫切除手术患者,随机均分为2组:羟考酮组(Q组)和羟考酮联合TAPB组(QT组),每组40例。Q组关腹前静注羟考酮0. 1 mg/kg,然后连接静脉自控镇痛泵(PCIA); QT组关腹前静注羟考酮0. 1 mg/kg,然后连接PCIA,并予手术结束即刻TAPB(双侧给予0. 375%罗哌卡因各15 ml)。两组PCIA均为羟考酮0. 8 mg/(kg·100 ml),背景剂量为2. 0 ml/h,病人自控剂量为0. 5 ml,锁定时间为15 min。记录并比较术后4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)视觉模拟疼痛评分(VAS)、Ramsay镇静评分,术后12 h时血糖及C-反应蛋白水平;术后12 h内PCIA按压次数。结果与Q组比较,QT组患者术后T1～T3时VAS评分降低(P <0. 05);术后12 h内Q组PCIA按压次数多于QT组(P <0. 05);两组血糖及C-反应蛋白水平均高于术前(P <0. 05),Q组血糖及C-反应蛋白水平高于QT组(P <0. 05); Q组和QT组患者术后Ramsay镇静评分比较差异无统计学意义(P> 0. 05)。TAPB时未出现脏器损伤及腹壁血肿等并发症。结论羟考酮联合TAPB可提高PCIA镇痛效果,减轻应激反应。

Objective To evaluate the effects of oxycodone combined transversus abdominis plane block （TAPB） on postoperative analgesia and stress response in patients undergoing laparoscopic hysterectomy. Methods A total of 80 patients undergoing laparoscopic hysterectomy under general anesthesia were randomly divided into two groups ：oxycodone group （group Q） and oxycodone combine with TAPB group （group QT） ,40 cases in each group. Group Q was intravenously injected with oxycodone 0. 1 mg/kg before closing the abdomen,and then was connected to the patient-controlled intravenous analgesia （PCIA） ;group QT was intravenously injected with oxycodone 0. 1 mg/kgbefore closing the abdomen, then was connected to PCIA, and immediately received TAPB （ bilateral TAPB with 0. 375% ropivacaine 15 ml） at the end of operation. The PCIA of two groups was 0. 8 mg/（kg·100 ml） of oxycodone with background dose of 2. 0 ml/h,and the patient controlled dose was 0. 5 ml,the lock time was 15 min. Postoperative 4 h （T1 ） ,8 h （T2 ） , 12 h （T3 ） ,24 h （T4 ） and 48 h （T5 ） visual analogue pain score （VAS） , Ramsay sedation score, postoperative blood glucose and serum level of reactive protein at 12 h,and the number of PCIA pressuring times in 12 h were recorded and compared. Results Compared with group Q,the VAS score of group QT was decreased at T1- T3 （P 〈0. 05） ;in 12 h after operation,the number PCIA pressing times in group Q was more than that of group QT （P 〈 0. 05 ） ;the blood glucose and C-reactive protein of the two groups were higher than those before operation （P 〈 0. 05 ） ; the blood glucose and C-reactive protein of group Q were higher than those of group QT （P 〈 0. 05 ） ;there was no significant difference in Ramsay sedation score between group Q and group QT after operation （ P 〉 0. 05 ）. No com- plication, such as visceral injuries and abdominal hematoma, were found during TAPB. Conclusion Oxycodone com- bined with TAPB can improve the analgesic effect of PCIA and relieve the stress response.