腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的作用

Application of transversus abdominis plane block in enhanced recovery after inguinal hernia repair

目的探讨腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的应用价值。方法选择2017年7月至2019年6月在南京大学医学院附属鼓楼医院行腹股沟疝修补术患者100例,年龄≥45岁,随机数字表法分为试验组(T组)和对照组(C组),每组各50例。T组患者全身麻醉后行患侧腹横肌平面阻滞(TAPB),给予0.375%罗哌卡因20 ml。记录所有患者术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、3 d(T5)静息和运动视觉模拟疼痛(VAS)评分;记录术中镇静药物和镇痛药物使用量及术后不良反应发生情况;记录术前、术后1、3、7 d医院焦虑抑郁量表(HADS)评分结果和简易智能精神状态量表(MMSE)评分结果。结果T组患者术后T1、T2、T3、T4时点静息和运动VAS评分显著低于C组(P<0.05),T5时点运动VAS评分显著低于C组(P<0.05);T组患者术中镇静药物、镇痛药物使用量较C组显著减少(P<0.05),术后恶心、呕吐发生率也显著降低(P<0.05);T组患者术后1 d HADS评分显著低于C组(P<0.05);T组患者术后1、3 d MMSE评分均显著低于C组(P<0.05)。结论TAPB可安全应用于腹股沟疝修补术患者,提供完善的术后镇痛效果,同时减少术后不良情绪的发生,预防术后认知水平的下降,符合术后快速康复的理念。

Objective To observe the effect of transversus abdominis plane block(TAPB)in patients undergoing inguinal hernia repair.Methods From July 2017 to June 2019,one hundred patients(age more than 45 years old)undergoing inguinal hernia repair in the Drum Tower Hospital affiliated to Nanjing University Medical College were divided into either TAP block group(group T)or control group(group C),with 50 cases in each group.Group T was treated with transversus abdominis plane block after general anesthesia while group C was treated with general anesthesia.The visual analogue scale scores at rest and on movement were applied to evaluate pain degrees 2 hours after surgery(T1),6 hours after surgery(T2),12 hours after surgery(T3),24 hours after surgery(T4),and 3 days after surgery(T5).The incidences of adverse reactions and the use of sedative drugs and analgesics after surgery were recorded.The hospital anxiety and depression scale(HADS)and mini-mental state examination(MMSE)were applied before surgery as well as 1,3 and 7 days after surgery.Results The VAS scores during rest and movement in group T at T1,T2,T3 and T4 were lower than that in group C(P<0.05).The VAS scores on movement in group T at T5 were lower than that in group C(P<0.05).The use of sedative drugs and analgesics were significantly lower in group T than that of group C(P<0.05).The incidences of nausea and vomiting in group T were lower than those in group C(P<0.05).The scores of HADS in group T were lower than those in group C at one day after surgery(P<0.05).The scores of MMSE in group T were lower than those in group C at both one day and three days after surgery(P<0.05).Conclusion TAPB can be safely applied to patients undergoing inguinal hernia repair.It provides an efficacy for postoperative analgesia as well as prevents the accident of depression and cognitive dysfunction after surgery,which accords with the idea of enhanced recovery after surgery.