腹横肌平面阻滞对腹腔镜胃癌根治术后快速康复的影响

Effect of Transverse Abdominal Plane Block on Rapid Recovery after Laparoscopic Radical Gastrectomy for Gastric Cancer

目的:观察超声引导下双侧肋缘下入路腹横肌平面阻滞在腹腔镜下胃癌根治患者围术期的应用效果。方法:选择全身麻醉下腹腔镜胃癌根治术患者40例,随机分为A组和B组各20例,A组麻醉诱导后行超声引导下用0.25%罗哌卡因20mL行双侧肋缘下入路腹横肌平面阻滞,B组常规全身麻醉,术后均接自控镇痛泵(PCIA)。记录围术期生命征变化;术中维持所用全身麻醉药用量及PCIA的按压次数;记录术后2、4、8、12h的VAS评分;记录术后首次下床活动时间、恶心呕吐发生率及恢复情况。结果:A组围术期血流动力学较B组平稳;A组术中镇痛药和七氟醚用量显著少于B组(P<0.05);与B组比较,A组术后4、8、12h的VAS评分也显著降低,PCIA按压次数显著减少(P<0.05);A组患者首次下床活动时间、胃肠道恢复时间、术后住院时间均少于B组(P<0.05)。结论:超声引导下腹横肌平面阻滞能有效阻断区域的神经传导,降低疼痛刺激的敏感性,从而减少全身麻醉药的用量,较平稳地渡过围术期,降低不良反应发生率,有利于患者的快速康复。

Objective:To observe the application of ultrasound-guided bilateral subcostal transverse abdominal plane block in laparoscopic radical gastrectomy for gastric cancer.Methods:40 patients undergoing laparoscopic radical gastrectomy under general anesthesia were randomly divided into two groups(n=20):group A with transverse abdominal plane block under general anesthesia combined with ultrasound guidance and group B with general anesthesia alone.After anesthesia induction,group A received ultrasound-guided transverse abdominal plane block through bilateral subcostal approach with 0.25%ropivacaine 20 mL,while group B received general anesthesia.Both groups received patient-controlled analgesia pump(PCIA)after operation.The changes of vital signs during perioperative period,the dosage of general anesthetics used during operation and the times of pressing PCIA were recorded.VAS scores at 2,4,8 and 12 hours after operation were recorded.The time of first ambulation,the incidence of nausea and vomiting and the recovery were recorded.Results:The perioperative hemodynamics of group A was more stable than that of group B;the dosage of analgesics and sevoflurane in group A was significantly less than that in group B(P<0.05);compared with group B,the VAS score of group A at 4,8 and 12 hours after operation was significantly lower,and the number of PCIA pressing was significantly reduced(P<0.05);the time of first ambulation,recovery of gastrointestinal tract and hospital stay in group A were less than those in group B(P<0.05).Conclusion:Ultrasound-guided transverse abdominal plane block can effectively block the nerve conduction in the region and reduce the sensitivity of pain stimulation,thus reducing the dosage of general anesthetics,smoothly passing through the perioperative period,and reducing the incidence of adverse reactions,which is conducive to the rapid recovery of patients.