羟考酮联合腹横肌平面阻滞对腹腔镜阑尾切除病人术后恢复的影响

Effect of oxycodone combined with transverse abdominal plane block on postoperative recovery in patients undergoing laparoscopic appendectomy

目的评价羟考酮联合腹横肌平面(TAP)阻滞对腹腔镜阑尾切除病人术后恢复的影响。方法选取在全麻下行腹腔镜阑尾切除术(LA)100例患者作为研究对象,美国麻醉医师协会(ASA)Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组(n=50):羟考酮联合TAP阻滞组(研究组)和静脉自控镇痛组(对照组)。研究组于全麻诱导后采用超声引导下行双侧TAP阻滞,并于手术结束前15 min静脉注射羟考酮0.10 mg/kg;对照组不进行TAP阻滞,仅采用全凭静脉全麻。待阑尾切除后静脉注射芬太尼2μg/kg,术毕行病人自控镇痛,维持数字评分法(NRS)评分≤4分。记录两组患者停药后自主呼吸恢复时间、苏醒时间、拔管时间及Ramsay镇静评分,并采用NRS评估患者静息时、活动时的疼痛程度及内脏痛。详细记录患者术后肛门首次排气时间、进流食时间、首次下床活动时间、术后住院时间和术后不良反应的发生情况。结果与对照组比较,研究组术毕自主呼吸恢复时间、苏醒时间、拔管时间差异均无统计学意义(t分别=1.95、1.11、0.79,P均>0.05),但Ramsay镇静评分明显升高(t=11.40,P<0.05),术后1 h、2 h、4 h、6 h、8 h、12 h静息时和活动时NRS评分明显降低(t分别=4.78、7.90、4.27、3.90、4.14、4.25;3.43、4.08、4.84、4.73、4.57、4.67,P均<0.05),术后1 h、2 h、4 h、6 h内脏痛NRS评分明显降低(t分别=10.52、10.60、7.02、6.54,P均<0.05),且术后追加帕瑞昔布钠镇痛的病例数明显减少(χ2=6.06,P<0.05)。研究组术后肛门首次排气时间、进流食时间、首次下床活动时间缩短(t分别=5.41、19.38、14.08,P均<0.05),尿潴留、恶心呕吐的发生率降低(χ2分别=7.16、12.71,P均<0.05)。结论羟考酮联合TAP阻滞可促进腹腔镜阑尾切除病人的术后恢复。

Objective To evaluate the effect of oxycodone combined with transverse abdominal plane block on postoperative recovery in patients undergoing laparoscopic appendectomy.Methods One hundred patients undergoing laparoscopic appendectomy under general anesthesia were divided into two groups with 50 cases in each according to a random number table.The study group was given oxycodone combined with TAP block,and the control group was given patient-controlled intravenous analgesia.For the patients in study group,the ultrasound-guided bilateral TAP block was performed after general anesthesia induction,and 0.10mg/kg of oxycodone was intravenously infused at 15 minutes before the end of the operation.For the patients in the control group,the total intravenous anesthesia was performed.And 2μg/kg of fentanyl was intravenously infused after appendectomy.Patient-controlled intravenous analgesia was performed for maintaining the numerical rating scale score≤4.The spontaneous breathing recovery times,awakening times,extubation times and Ramsay scores were recorded respectively in both groups.The pain at rest and activity time,visceral pain were assessed by using numerical rating scale(NRS).Time to first flatus,time to liquid diet,first ambulation time,length of hospital stay after operation and adverse reactions were recorded.Results The differences in the spontaneous breathing recovery time,awakening time,extubation time between two groups were not statistically significant(t=1.95,1.11,0.79,P>0.05),but the Ramsay score of the study group was significantly higher than that of the control group(t=11.40,P<0.05).One hour,2 hours,4 hours,6 hours,8 hours and 12 hours after operation,the NRS scores at the rest and activity time of the study group were significantly lower than those of the control group as well as the NRS scores of visceral pain at 1 hour,2 hours,4 hours and 6 hours(t=4.78,7.90,4.27,3.90,4.14,4.25,3.43,4.08,4.84,4.73,4.57,4.67,10.52,10.60,7.02,6.54,P<0.05).Compared with the control group,the number of patients who required Parecoxib for analgesia in study group were decreased significantly(χ2=6.06,P<0.05).The time to first natus,time to 1iquid diet and first ambulation time of study group were significantly shortened(t=5.41,19.38,14.08,P<0.05),the incidences of urinary retention and nausea and vomiting of study group were significantly decreased(χ2=7.16,12.71,P<0.05).Conclusion Combination of oxycodone and transverse abdominal plane block can promote postoperative recovery in the patients undergoing laparoscopic appendectomy.