超声引导下腹横肌平面阻滞对腹腔镜结直肠癌根治术后疼痛及康复的影响

Effect of ultrasound-guided transversus abdominis plane block on pain and rehabilitation after laparoscopic radical resection of colorectal cancer

目的观察超声引导下腹横肌平面阻滞对腹腔镜结直肠癌根治术后疼痛及术后康复的影响。方法选取2019年1~12月于我院行腹腔镜结直肠癌根治术的78例患者为研究对象,采用随机数字表法将其分成参照组(39例)与研究组(39例)。参照组术后单纯予以自控静脉镇痛,研究组予以超声引导下腹横肌平面阻滞+患者静脉自控镇痛。比较两组术后疼痛视觉模拟量表(VAS)评分、第一次需求自控镇痛泵(PCA)距离清醒拔管的时间、镇痛泵按压次数、术后24h内舒芬太尼使用量、镇痛满意度评分、术后恢复时间及住院时间、术后不良反应发生率。结果研究组患者术后2、6、12、24、48h的VAS评分均低于参照组,差异有统计学意义(P<0.05);研究组患者镇痛泵按压次数、术后24h内舒芬太尼使用量小于参照组,镇痛满意度评分高于参照组,差异有统计学意义(P<0.05);研究组第一次需求PCA距离清醒拔管的时间长于参照组,差异有统计学意义(P<0.05);研究组术后肛门排气、拔除尿管、流质饮食的时间及住院时间均短于参照组,差异有统计学意义(P<0.05);研究组患者术后头晕、恶心、呕吐等不良反应总发生率低于参照组,差异有统计学意义(P<0.05)。结论对腹腔镜结直肠癌根治术患者应用超声引导下腹横肌平面阻滞,可有效减轻患者疼痛,减少术后镇痛泵药物使用剂量,促进患者术后恢复,且不良反应少,值得临床推广。

Objective To observe the impacts of ultrasound-guided transversus abdominis plane block on pain and rehabilitation after laparoscopic radical resection of colorectal cancer.Methods A total of 78 patients treated with laparoscopic radical resection of colorectal cancer in our hospital from January to December 2019 were selected as the research objects and were divided into the reference group(n=39)and the study group(n=39)by the random number table method.Patients in the reference group were given intravenous patient-controlled analgesia(PCA)after operation,while patients in the study group were given ultrasound-guided transversus abdominis plane block combined with intravenous PCA.The visual analogue scale(VAS)of postoperative pain,the time from the first demand of PCA to awake extubation,the pressing times of PCA,the dosage of sufentanil used within 24 hours after operation,the analgesic satisfaction degree score,the rehabilitation time and hospitalization time after operation,and the incidence rate of postoperative adverse reactions(ADRs)were compared between the two groups.Results The VAS scores in the study group at 2h,6h,12h,24h and 48h after operation were lower than those in the reference group,the differences were statistically significant(P<0.05).The pressing times of PCA and the dosage of sufentanil used within 24 hours after operation in the study group were less than those in the reference group,and the analgesic satisfaction degree score was higher than that in the reference group,the differences waere statistically significant(P<0.05).The time from the first demand of PCA to awake extubation in the study group was longer than that in the reference group,the difference was statistically significant(P<0.05).The time of postoperative anus exhaust,removal of urinary catheter,liquid diet and hospitalization in the study group were all shorter than those in the control group,the differences were statistically significant(P<0.05).The total incidence rates of dizziness,nausea and vomiting in the study group were lower than those in the reference group,the difference was statistically significant(P<0.05).Conclusion The application of ultrasound-guided transversus abdominis plane block in patients who received laparoscopic radical resection of colorectal cancer can effectively relieve the pain of patients,reduce the dosage of PCA used after operation,and promote their postoperative rehabilitation with few ADRs,which is worthy of clinical promotion.