超声引导下腹横肌平面阻滞对子宫内膜癌手术患者苏醒质量和镇痛效果的影响

Influence of ultrasound-guided transversus abdominis plane block on the quality of awakening and analgesic effect in patients with endometrial carcinoma

目的探讨超声引导下腹横肌平面阻滞(TAPB)对子宫内膜癌手术患者苏醒质量和镇痛效果的评价。方法选取2017年6月~2018年12月于我院就诊并手术治疗的子宫内膜癌患者80例作为研究对象,按随机数字表法将其分为对照组和观察组,每组各40例。对照组采取硬膜外阻滞麻醉,观察组则采取TAPB进行麻醉,术后均予以静脉自控镇痛泵。比较两组的苏醒时间及Steward苏醒评分,术中镇痛药总用量、术后4、8、24及48h视觉模拟量表(VAS)评分、术后镇痛泵按压次数。观察两组不良反应发生情况。结果观察组的苏醒时间、自主呼吸时间、拔管时间显著短于对照组(P<0.05),观察组的Steward苏醒评分则显著高于对照组(P<0.05)。观察组术后4、8及24h的VAS评分均显著低于对照组(P<0.05)。观察组镇痛泵按压次数及镇痛药物总用量均显著少于对照组(P<0.05)。两组在麻醉过程中均未出现严重不良反应。结论TABP用于子宫内膜癌手术麻醉阻滞定位准确,苏醒时间较快,术后镇痛效果较好,不良反应发生率较低。

Objective To explore the influence of ultrasound-guided transversus abdominis plane block(TAPB)on the quality of awakening and analgesic effect in patients with endometrial carcinoma.Methods A total of 80 cases of endometrial cancer patients admitted to our hospital from June 2017 to December 2018 for concurrent surgical treatment were selected as the study subjects.According to the random number table method,they were divided into the control group and the observation group,40 cases in each group.The control group received epidural block and the observation group received TAPB anesthesia.The total amount of analgesics during operation,visual analogue pain(VAS)score at 4,8,24 and 48 h after operation,and the number of postoperative analgesic pump compressions were compared.The adverse reactions of the two groups were observed.Results The waking time,spontaneous breathing time and extubation time of the observation group were significantly shorter than those of the control group(P<0.05),and the Steward waking score of the observation group was significantly higher than that of the control group(P<0.05).VAS scores of patients in the observation group at 4,8 and 24 h after surgery were significantly lower than those in the control group(P<0.05).The number of analgesic pump compressions and the total dosage of analgesic drugs in the observation group were significantly less than those in the control group(P<0.05).No serious adverse reactions occurred during anesthesia in the two groups.Conclusion TABP is applied to endometrial cancer surgery for accurate positioning of anesthesia block,,rapid recovery time,good postoperative analgesia effect,and low incidence of adverse reactions.