超声引导TAPB对老年直肠癌患者根治术后镇痛的效果

Effect of ultrasonic-guided TAPB on post-radical operation analgesia for senile patients with rectal cancer

目的观察超声引导腹横肌平面阻滞(TAPB)对腹腔镜直肠癌根治术老年患者术后镇痛的效果。方法将腹腔镜直肠癌根治术老年患者64例随机分为阻滞组与对照组,各32例。阻滞组于全麻诱导后行超声引导TAPB,静注0.25%盐酸罗哌卡因30 ml;对照组静注等容量生理盐水。术后均给予静脉镇痛泵镇痛。比较两组麻醉前(T0)和术后1 h(T1)、12 h(T2)、24 h(T3)及48 h(T4)时的疼痛视觉模拟评分(VAS评分)及血流动力学指标变化;统计两组术后24 h内镇痛泵按压次数及舒芬太尼用量及术后不良反应发生情况。结果与对照组比较,阻滞组于T1、T2时点平均动脉压(MAP)降低,T1、T2及T3时点心率(HR)均降低(P<0.05);阻滞组组内比较,T1时点MAP高于T0时点,T1和T2时点HR均高于T0时点(P<0.05)。与对照组比较,阻滞组T1、T2、T3、T4时点VAS评分均更低,且术后24 h内镇痛泵按压次数及舒芬太尼用量均降低(P<0.05),不良反应发生率也降低(P<0.05)。结论超声引导TAPB用于腹腔镜直肠癌根治术老年患者术后镇痛效果较佳,术中血流动力学平稳,术后疼痛程度降低,且安全性好。

Objective To observe the effect of ultrasonic-guided TAPB on post-radical operation analgesia for senile patients with rectal cancer.Methods A total of 64 senile patients subject to laparoscopic resection of rectal cancer were randomly divided into a block group and a control group(n=32,respectively).Ultrasonic-guided TAPB w,as performed in the block group after general anesthesia induction,and then 0.25%ropivacaine hydrochloride(30 ml)was injected;equivalent volume of normnal saline was given to the control group.Both groups were given PCIA for analgesia after the operation.The visual analogue scales(VAS)and changes in hemodynamic indicators before the anesthesia(T0)and 1 h(T1),12 h(T2),24 h(T3)and 48 h(T4)after the operation were compared between the two groups.Statistics were made on the presses of PCIA 24 h after the operation,the dosage of sufentani and the occurrence of untoward effects in both groups.Rults In comparison with the control group,the block group had lower mean arterial pressure(MAP)at T1 and T2;the heart rate in the control group decreased at T1,T2 and T3(both P<0.05);within the block group,MAP was higher at T1 than at T0,and heart rate was higher at T1 and T2 than at T0(both P<0.05).In comparison with the control group,the VAS scores in the block group were lower at T1,T2,T3 and T4.Besides,both PCIA presses and sufentani dosage were reduced in 24 h after the operation(both J5<0.05).The incidence of untoward effect also decreased(P<0.05).Conclusion The effect of ultrasonic-guided TAPB on post-radical operation analgesia for senile patients with rectal cancer is favorable.Hemodynamics is stable during the operation and the degree of pain decreases after the operation.There is also high safety in this procedure.