腹腔镜胆囊切除术中应用腹横肌平面阻滞对术后镇痛效果和应激指标的影响

Effect of transversus abdominis plane block applied in laparoscopic cholecystectomy on postoperative analgesia effect and stress indexes

目的:探讨腹腔镜胆囊切除术(LC)中应用腹横肌平面(TAP)阻滞对术后镇痛效果、应激指标的影响。方法:选择某院择期行LC治疗患者90例,根据其麻醉方式分为对照组(42例)和研究组(48例),2组均于麻醉诱导后接受超声引导下TAP定位进针,其中对照组注射生理盐水,研究组注射罗哌卡因。比较2组患者术后相关指标、镇痛效果、应激指标及不良反应情况。结果:研究组拔管时间短于对照组(P<0.05);重复测量方差显示2组患者VAS评分、Ramsay评分和各项应激指标水平在组间、各时间点比较和交互效应上均具有统计学意义(P<0.05);研究组术后不良反应发生率明显低于对照组,差异有统计学意义;麻醉中和麻醉后2组患者HR、MAP比较差异有统计学意义(P<0.05)。结论:TAP阻滞应用于LC患者术后镇痛安全、有效,可明显减轻其术后应激反应,促进术后恢复。

Objective:To study the effect of transversus abdominis plane(TAP)block applied in laparoscopic cholecystectomy(LC)on postoperative analgesia effects and stress indexes.Methods:90 patients undergoing elective LC were selected and,according to anesthesia method adopted,were divided into a control group and an observation group.All underwent ultrasound-guided TAP determine the insertion location after anesthesia induction.The control group was injected with normal saline,while the observation group was injected with ropivacaine.Postoperation related indexes,analgesia effect,stress indexes and adverse reactions were compared between the two groups.Results:There was no significant difference in postoperative wake-up time or respiration recovery time between the two groups(P>0.05).The extubation time of the observation group was significantly shorter than that of the control group(P<0.05).Repetitive measurement and analysis of variance showed that there were significant differences in VAS scores,Ramsay scores and levels of stress response indexes between groups at the same time point,in the same group at different time points and between groups at different time points(P<0.05).After surgery,the incidence of adverse reactions in the observation group was significantly lower than that in the control group.There were significant differences in HR and MAP between the two groups of patients during and after analgesia(P<0.05).Conclusion:TAP block is safe and effective for postoperative analgesia in patients undergoing LC,which can significantly alleviate postoperative stress response,and promote postoperative recovery.