超声引导肋缘下腹横肌平面阻滞对腹腔镜胆囊术后恢复质量的影响

Effect of ultrasound-guided subcostal transversus abdominis plane block on recovery quality after laparoscopic gallbladder surgery

目的探讨超声引导肋缘下腹横肌平面(TAP)阻滞对腹腔镜胆囊切除术后早期恢复质量的影响。方法选择2018年1~12月我院择期腹腔镜胆囊切除手术患者62例,随机分为观察组和对照组。手术结束后,观察组患者予以超声引导双侧肋缘下腹横肌平面阻滞,对照组不予干预,术后观察两组患者各时间点HR、MAP、SpO2、疼痛评分、恶心呕吐、肛门排气时间、下床活动时间、术后补救镇痛次数;记录术后24 h QoR-40评分,比较两组患者的舒适度。结果与对照组相比,观察组术后4 h、8 h的HR均显著低于对照组(P<0.05);观察组患者拔管后5 min、术后2 h、4 h及术后8 h的VAS评分,均显著低于对照组(P<0.05);观察组患者肛门排气时间显著缩短,下床活动时间及术后补救镇痛次数也优于对照组,差异有统计学意义(P<0.05);与对照组相比,观察组QoR-40总分较高,主要体现在情绪状态、身体舒适度和疼痛等主观感受方面,差异有统计学意义(P<0.05)。结论超声引导肋缘下腹横肌平面阻滞用于腹腔镜胆囊术后镇痛,可以降低患者术后疼痛评分,减少术后恶心、呕吐等不良反应的发生率,维持血流动力学平稳,有效提升腹腔镜胆囊切除术后患者早期恢复质量。

Objective To investigate the effect of ultrasound-guided subcostal transversus abdominis plane(TAP)block on early recovery quality after laparoscopic cholecystectomy.Methods A total of 62 patients undergoing elective laparoscopic cholecystectomy from January to December 2018 were randomly divided into observation group and control group.After the operation,patients in the observation group were given ultrasound-guided bilateral subcostal transversus abdominis plane block.The control group did not receive the intervention.The HR,MAP,SpO2,pain score,nausea and vomiting,anal exhaust time,the time of getting out of bed,and number of additional pain medications after surgery in the two groups were observed and recorded after surgery.QoR-40 score was recorded 24 hours after surgery.The comfort between the two groups was compared.Results The HR of the observation group at 4 h and 8 h after surgery was significantly lower than that of the control group.The VAS scores of the observation group at 5 min after the extubation,at 2 h,4 h and 8 h after surgery were significantly lower than those of the control group.The anal exhaust time was significantly shorter in the observation group,and the time of getting out of bed and the number of postoperative remedial analgesia were better than those of the control group,and the differences were statistically significant(P<0.05).The total analgesic QoR-40 score in the observation group was higher than that in the control group,mainly in the subjective experience such as emotional state,physical comfort and pain,and the differences were statistically significant(P<0.05).Conclusion Ultrasound-guided subcostal transversus abdominis plane block for analgesia after laparoscopic gallbladder surgery can reduce patients'postoperative pain score,reduce the incidence of postoperative nausea,vomiting and other adverse reactions,maintain stable hemodynamics,and effectively improve early recovery quality of patients after laparoscopic cholecystectomy.