腹横肌阻滞对腹腔镜袖状胃切除术后镇痛效果观察

Effect of transversus abdominis plane block on analgesia and inflammatory factor after laparoscopic sleeve gastrectomy

目的:探讨超声引导下腹横肌平面(TAP)阻滞对严重肥胖患者腹腔镜袖状胃切除术(LSG)术后疼痛和炎性因子的影响。方法:80例行LSG手术的严重肥胖患者,随机分为实验组和对照组各40例。实验组和对照组患者在全身麻醉后切皮前在超声引导下进行TAP阻滞,其中实验组患者双侧TAP分别予以0.375%罗哌卡因20 mL注射,对照组予以20 mL生理盐水注射,术毕进行静脉自控镇痛。比较两组患者术后视觉模拟评分(VAS)、术后第1次补救性镇痛时间、术后卧床时间、胃肠道恢复时间、住院时间、围手术期血清白细胞介素-6(IL-6)水平、术后并发症发生情况等。结果:实验组术后1 h、2 h、6 h、12 h、18 h和24h的静息状态VAS评分均明显低于对照组(P<0.05)。实验组术后第1次补救性镇痛时间晚于对照组,术后卧床时间、胃肠道恢复时间和住院时间等均显著短于对照组(P<均0.05)。实验组患者术后24 h和48 h血清IL-6水平显著低于对照组(P均<0.05)。实验组患者术后恶心呕吐发生率显著低于对照组(P<0.05)。结论:超声引导下TAP阻滞能够有效控制LSG术后疼痛,减轻术后炎症反应,降低术后并发症并促进术后恢复。

Objective:To investigate the effects of ultrasound-guided transversus abdominis plane(TAP)block on pain and inflammatory factors in patients with severe obesity after laparoscopic sleeve gastrectomy(LSG).Methods:80 patients with severe obesity undergoing LSG surgery were prospectively enrolled,and divided into experimental group and control group by random number table,40 cases for each group.All patients received TAP block under ultrasound guidance before the general anesthesia.In the experimental group,the bilateral TAP was injected with 20 mL of 0.375%ropivacaine,but control group was injected with 20 mL of saline.Both groups were given patient controlled intravenousanalgesia after operation.Postoperative visual analogue scale(VAS),postoperative first remedial analgesia time,postoperative bed time,gastrointestinal recovery time,hospitalization days,perioperative serum Interleukin-6(IL-6)levels and postoperative complications were compared between two groups.Results:The VAS scores in experimental group at 1 h,2 h,6 h,12h,18 h and 24 h postoperation were significantly lower than those of control group(P<0.05).The first remedial analgesia time in experimental group was later than that in control group,and the postoperative bed time,gastrointestinal recovery time and hospitalization days were significantly shorter than control group(P<0.05).Serum IL-6 levels in experimental group were significantly lower than those in control group at 24h and 48h postoperation(P<0.05).The incidence of postoperative nausea and vomiting in experimental group was significantly lower than that in control group(P<0.05).Conclusion:Ultrasound-guided TAP block can effectively control the postoperative pain of LSG,reduce postoperative inflammatory response,reduce postoperative complications and promote postoperative recovery.