超声引导下双侧腹横肌平面阻滞与自控静脉镇痛应用于开腹直肠癌根治术患者的效果观察

Observation on the Effects of Ultrasound-Guided Bilateral Transversus Abdominis Plane Block and Patient-Controlled Intravenous Analgesia Applied in Patients with Open Radical Resection of Rectal Cancer

目的比较超声引导下双侧腹横肌平面阻滞与自控静脉镇痛应用于开腹直肠癌根治术患者的效果。方法76例开腹直肠癌根治术患者随机分为两组各38例。A组给予超声引导下双侧腹横肌平面阻滞,B组给予自控静脉镇痛。比较两组的临床指标,以及术后疼痛程度、恢复情况、不良反应。结果A组的瑞芬太尼用量显著低于B组(P<0.05),两组的丙泊酚用量、尿量、出入液体总量、术中出血量无显著差异(P>0.05)。术后2 h、12 h、24 h,A组咳嗽以及静息时的NRS评分均显著低于B组(P<0.05);术后48 h、72 h,两组咳嗽以及静息时的NRS评分均无显著差异(P>0.05)。A组的首次排气时间、下床活动时间、住院时间、补救镇痛比例和恶心呕吐发生率均显著低于B组(P<0.05)。结论超声引导下双侧腹横肌平面阻滞应用于开腹直肠癌根治术可明显缓解患者的疼痛,减少麻醉不良反应,改善患者的预后。

Objective To compare the effects of ultrasound-guided bilateral transversus abdominis plane block and patient-controlled intravenous analgesia applied in patients with open radical resection of rectal cancer.Methods 76 patients with open radical resection of rectal cancer were randomly divided into two groups,with 38 cases in each group.Group A was given ultrasound-guided bilateral transversus abdominis plane block,and group B was given patient-controlled intravenous analgesia.The clinical indicators,as well as postoperative pain degree,recovery and adverse reactions were compared between two groups.Results The dosage of remifentanil in group A was significantly lower than that in group B(P<0.05),while no significant difference was found in the dosage of propofol,the amount of urine,the amount of fluid in and out,and the amount of intraoperative blood loss between the two groups(P>0.05).At 2,12 and 24 hours after surgery,the NRS scores when coughing and when resting in group A were significantly lower than those in group B(P<0.05),while no statistical difference was found in the NRS scores when coughing and when resting at 48 and 72 hours after surgery between two groups(P>0.05).The time of first exhaustion,time to get out of bed,length of hospital stay,proportion of salvage analgesia and incidence of nausea and vomiting in group A were significantly lower than those in group B(P<0.05).Conclusions Ultrasound-guided bilateral transversus abdominis plane block applied in open radical resection of rectal cancer can obviously relieve patients'pain,reduce the adverse reactions of anesthesia and improve patients'prognosis.