超声引导肋下斜入路TAP对胃肠癌术后疼痛的影响

Effect of Ultrasound-guided Subcostal Oblique Approach TAP on Postoperative Pain With Gastrointestinal Carcinoma

目的探讨超声引导肋下斜入路腹横肌平面(TAP)阻滞用于腹腔镜胃肠癌根治术患者镇痛效果。方法选取2018年2—10月择期该手术患者60例。随机分两组,对照组(A组):术毕使用PCIA,TAP组(B组):术毕实施TAP阻滞联合PCIA的多模式镇痛。对比两组苏醒期的HR、SBP、SDP,安静及活动时术后2h、6h、12h、24h的疼痛视觉模拟评分,首次按压镇痛泵时间及按压次数,术后24h内镇痛泵舒芬太尼用量,及发生胸闷、呼吸抑制、恶心、呕吐等不良反应。结果与A组相比,B组血流动力学更平稳、疼痛评分更低、首次按压镇痛泵时间更长、按压次数更少、24h舒芬太尼用量更少。结论超声引导肋下斜入路TAP镇痛效果好,持续时间较长,减少了术后阿片类药物的用量,无明显不良反应;该多模式镇痛利于术后快速康复。

Objective To investigate the efficacy of ultrasound-guided subcostal oblique transversus abdominis plane block of postoperative analgesia in patients underwent radical operation of gastrointestinal carcinoma. Methods A total of 60 patients were selected for elective operation from February to October 2018. They were randomly divided into two groups: the control group (group A) was given PCIA after the operation, TAP group(group B) was given multimodal analgesia of transversus abdominis plane block combined with PCIA after the operation. Compare HR, SBP, SDP of awakening period and visual analogue scale (VAS) of quiet and activities state of two groups postoperative patients after 2 h, 6 h, 12 h, 24 h, and the first time to press analgesia pump, and press numbers, and the analgesia pump sufentanil dosage within postoperative 24 hours, chest congestion, respiratory depression, nausea, emesis and other adverse reactions. Results Compared with group A, group B had more stable hemodynamics, lower pain scores, longer initial analgesic pump, fewer compressions, and less sufentanil in 24 hours. Conclusion The analgesic effect of ultrasoundguided subcostal oblique TAP is good, the duration is longer, the dosage of opioid drugs is reduced, and there is no obvious adverse reaction, the multimode analgesia is beneficial to the rapid recovery after operation.