超声引导下腹横肌平面阻滞在腹腔镜子宫切除术中炎性因子和术后康复的研究

Effect of Ultrasound-guided Transversus Abdominis Plane Block on Inflammatory Cell and Recovery after Surgery in Patients Undergoing Laparoscopic Hysterectomy

目的:探讨超声引导下腹横肌平面阻滞在腹腔镜子宫切除术对炎性因子和术后康复的影响。方法:选择50例行择期腹腔镜子宫切除术的患者,随机分成腹横肌平面阻滞组(TAP组)和对照组,每组25例。TAP组全身麻醉后切皮前超声引导行双侧腹横肌平面阻滞,予0.25%罗哌卡因40 ml,每侧20 ml,对照组全身麻醉后切皮前不做任何神经阻滞处理。两组术毕均行静脉自控镇痛。比较两组患者术中术后镇痛药物总量,以及术后2、12、24、48 h视觉模拟评分(VAS评分)、术后卧床时间、首次肛门排气时间、导尿管拔除时间、术后住院时间、该阻滞部位腹腔内脏器损伤、穿刺部位感染、血肿等腹横肌平面阻滞并发症及静脉镇痛相关不良反应等指标。分别于术前、术后即刻及24、48 h测定血浆IL-6水平。结果:TAP组术中术后镇痛药物总量及术后2、12、24 h时VAS评分均低于对照组,差异均有统计学意义(P<0.05),两组术后48 h时VAS评分比较差异无统计学意义(P>0.05)。TAP组首次肛门排气时间早于对照组,术后卧床时间、导尿管拔除时间、术后住院时间均短于对照组,差异均有统计学意义(P<0.05)。TAP组恶心呕吐发生率低于对照组,差异有统计学意义(P<0.05)。TAP组术后即刻及24 h血浆IL-6均低于对照组,差异均有统计学意义(P<0.05)。结论:超声引导下腹横肌平面阻滞术后镇痛效果好,炎性因子释放减少,不良反应少,促进术后康复。

Objective:To observe the effect of ultrasound-guided transversus abdominis plane block on inflammatory cell and recovery after surgery in patients undergoing laparoscopic Hysterectomy.Methed:A total of 50 patients undergoing laparoscopic hysterectomy were randomly divided into two groupsultrasound-guided transversus abdominis plane block(TAP group)and control group,with 25 cases in each group.After received general anaesthesia,TAP group received an ultrasound-guided bilateral transversus abdominis plane block using 0.25%Ropicaine 40 ml(20 ml for each side)before skin incision,while control group was given no nervus block.Both groups were given PCIA after operation.The total amount of analgesic during the operation,the score of VAS at 2,12,24,48 h after operation,bed time after operation,first anus exhaust time,time to pull out urinary canal,hospitalization daysincidence of adverse reactions of two groups were observed and recorded.IL-6 was checked before and after operation at 24,48 h.Result:The total amount of analgesic drugs in TAP group and VAS score at 2,12,24 h after operation were lower than those in control group,the differences were statistically significant(P<0.05).There was no statistically significant between two groups in the score of VAS at 48 h(P>0.05).The first anus exhaust time in TAP Group was earlier than control group,the duration of bed rest,catheter removal and postoperative hospitalization were shorter than those in the control group,the differences were statistically significant(P<0.05).The incidence of nausea and vomiting in TAP group was lower than that in control group,the difference was statistically significant(P<0.05).The plasma IL-6 in TAP group was lower than that in control group immediately after operation and 24 h after operation,the differences were statistically significant(P<0.05).Conclusion:Ultrasound-guided transversus abdominis plane block can reduce postoperative analgesic requirement after laparoscopic Hysterectomy,morever,it can reduce phlogotic reaction and untoward effect which can promote postoperative recovery.