摘要
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.
作者
金文英
李林
JIN Wen-ying;LI Lin(Department of Anesthesiology,General Hospital of Shenyang Military Region,Shenyang 110016,China)
出处
《实用药物与临床》
CAS
2018年第9期1043-1046,共4页
Practical Pharmacy and Clinical Remedies
关键词
术后镇痛
羟考酮
腹横肌平面阻滞(TAPB)
应激反应
Postoperative analgesia
Oxycodone
Transversus abdominis plane block( TAPB )
Stress response