腹横肌平面阻滞在机器人肾部分切除术中的应用

Application of Transverse Abdominis Planar Block in Robotic Partial Nephrectomy

目的评价腹横肌平面阻滞(TAP)在机器人肾部分切除术中的应用效果。方法择期腹腔镜肾脏肿瘤切除手术患者60例,患者年龄29~76岁,ASA分级Ⅰ~Ⅲ级。采用数字表法随机分为两组(n=30):腹横肌平面阻滞组(R组)和对照组(C组)。R组于麻醉诱导结束后超声引导下行手术侧腹横肌平面阻滞,注射0.375%罗哌卡因20ml。C组于麻醉诱导结束后在手术侧腹横肌平面注射0.9%氯化纳溶液20ml。两组患者术后采用静脉镇痛(PCA),芬太尼10μg/kg+氟比洛芬酯300mg,生理盐水稀释至100ml,无背景剂量,PCA剂量4ml,锁定时间5min。记录患者诱导前、诱导后3min、气腹后即刻、手术开始后60min、术毕各时间点的平均动脉压(MAP)和心率(HR),术中芬太尼用量,术后2、6、12、24、48h的静态VAS和动态VAS,术后PCA用量,术后24h恶心、呕吐、头晕、皮肤瘙痒的发生率、术后排气时间和进食时间。结果与C组比较,R组在术后2、6h的静态和动态VAS降低,差异有统计学意义(P<0.05);两组在术后12、24、48h的VAS比较,差异无统计学意义(P>0.05)。与C组比较,R组术后恶心、呕吐发生率降低,差异有统计学意义(P<0.05)。与C组比较,R组术后PCA用量减少,差异有统计学意义(P<0.05)。两组之间术中芬太尼用量、术后排气时间和进食时间比较,差异无统计学意义(P>0.05),且R组未见腹横肌平面阻滞有关不良事件发生。结论腹横肌平面阻滞用于机器人肾部分切除术安全有效。

Objective To evaluate the effect of transverse abdominis planar block(TAP)in robotic partial nephrectomy.Methods Sixty patients with selective laparoscopic resection of renal tumor,aged 29-76 years,ASA gradeⅠ-Ⅲ.Two groups(n=30)were divided by random number table method:TAP group(group R)and control group(group C).In group R,after anesthesia induction,ultrasound-guided transverse ventral muscle plane block was performed and 0.375%ropivacaine was injected with 20ml.In group C,20ml of normal saline was injected into the transverse ventral muscle plane after anesthesia induction.Patients in the two groups were treated with patient-controlled analgesia(PCA).Fentanyl(10μg/kg)and flurbiprofen axetil(300mg)were diluted to 100ml with normal saline,with no background dose,and the PCA dose was 4ml and locked for 5min.Mean arterial pressure(MAP)and heart rate(HR)intraoperative fentanyl dosage,postoperative 2,6,24,48h of static dynamic VAS,VAS and PCA dosage postoperatively,24h after the incidence of nausea and vomiting,dizziness,skin itching,postoperative exhaust time and feeding time were recorded i before and after induction 3min,pneumoperitoneum immediately,60min after the operation and each point.Results Compared with the group C,the static and dynamic VSA scores of the group R decreased at 2 and 6h after surgery,with statistically significant difference(P<0.05).There was no significant difference in VSA scores between the two groups at 12,24,48h after surgery(P>0.05).Compared with group C,the incidence of postoperative nausea and vomiting in group R was reduced,with statistically significant difference(P<0.05).Compared with the group C,the amount of PCA in the group R decreased,with statistically significant difference(P<0.05).There was no significant difference in intraoperative fentanyl dosage,postoperative exhaust time and feeding time between the two groups(P>0.05).No adverse events related to transverse abdominis plane block were observed in group R.Conclusion Transverse abdominis block is safe and effective for robotic partial nephrectomy.