超声引导下腹横筋膜平面阻滞应用于肾移植围术期的镇痛效果评价

The Peri-Operative Analgesic Effect of Ultrasound-Guided Transversus Abdominis Plane on Patients Undergoing Renal Transplantation

目的探讨超声引导下行腹横筋膜平面(Transversus Abdominis Plane,TAP)阻滞的术中镇痛效果和持续镇痛时间,阐明其用于同种异体肾移植术中及术后镇痛的有效性和可行性。方法选取40名同种异体肾移植手术患者,随机分为TAP组(n=20)和对照组N组(n=20)。TAP组患者于全麻诱导后行超声引导下双侧TAP阻滞,对照组不进行操作。观察切皮前后2组患者的收缩压(SBP)、舒张压(DBP)和心率(HR)的变化,记录2组患者术中芬太尼用量。所有患者术后使用舒芬太尼进行术后镇痛,记录2组患者术后疼痛(VAS)评分以及镇痛药物使用量。并且比较两组患者对于镇痛的满意度。结果两组患者ASA分级、年龄、体重以及手术时间比较差异无统计学意义。切皮前后HR、SBP和DBP比较TAP组明显小于N组,差异有统计学意义(P <0. 05)。TAP组术中芬太尼及术后24 h PCIA药物用量明显少于N组,差异有统计学意义(P <0. 05); TAP组患者拔管时间、术后躁动及苏醒延迟发生率及术后VAS评分低于N组(P <0. 05); TAP组患者对于术后镇痛方式的满意度明显高于N组(P <0. 05)。结论使用40 m L 0. 375%罗哌卡因进行超声引导下双侧TAP阻滞复合全身麻醉,对同种异体肾移植手术患者具有较好的围术期镇痛效果,减少镇痛药物用量及副作用,促进恢复。

Ojbective Transversus abdominis plane(TAP)block has been reported to provide effective analgesia after lower abdominal surgery,this study was to investigate the effect of ultrasound-guided TAP block in patients undergoing renal transplantation.Methods Forty patients undergoing renal transplantation were randomly allocated to two Groups.Group TAP receive ultrasound-guided TAP block before surgery but Group N don’t receive TAP block.Patients were monitored for the variance of systolic blood pressure;diastolic blood pressure;heart rate;total dosage of fentanyl during operation.Sufentanil was applicated on post-operation analgesia.Extubation time,postoperative agitation,delayed recovery,VAS score and dosage of PCIA were recorded.Results There were no significant differences in ASA classification,age,weight,and operative time between the two groups.The HR,SBP and DBP before and after incision were significantly smaller than those in the TAP group,and the difference was statistically significant(P<0.05).The dose of PCIA in TAP group was significantly lower than that in N group after24hours after operation(P<0.05).The time of extubation,postoperative agitation and recovery delay and postoperative VAS in TAP group The scores were lower than those in the N group(P<0.05).The satisfaction of postoperative analgesia was significantly higher in the TAP group than in the N group(P<0.05).Conclusion General aneasthesia combined with ultrasound-guided TAP block can provided better pain control and better recovery after surgery.