超声下腹横肌平面阻滞对直肠癌根治术患者镇痛及不良反应的影响

Effect of transverse abdominal plane block under ultrasound on analgesia and adverse reactions in patients undergoing radical resection of rectal cancer

目的探讨超声下腹横肌平面(TAP)阻滞对腹腔镜下行直肠癌根治术患者镇痛及不良反应的影响。方法按照随机数字表法将腹腔镜下行直肠癌根治术的80例直肠癌患者分为TAP组和对照组,各40例。TAP组患者在超声引导下行TAP阻滞,对照组患者行常规麻醉。比较两组患者的麻醉时间、手术时间、术后首次下床时间、术后首次排气时间、住院时间,比较不同时间点[麻醉前(T0)、术后1 h(T_(1))、术后12 h(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))]的循环指标[平均动脉压(MAP)、心率(HR)]和视觉模拟量表(VAS)评分,以及术前1天、术后3天的40项恢复质量评分量表(QoR-40)评分,记录两组患者术后舒芬太尼用量、患者自控镇痛(PCA)输注量、每24小时有效按压次数及术后24 h内不良反应发生情况。结果TAP组患者的术后首次下床时间、术后首次排气时间、住院时间均短于对照组患者(P﹤0.05)。TAP组患者T_(1)、T_(2)时刻MAP、HR均低于对照组,T_(1)、T_(2)、T_(3)、T_(4)时刻的VAS评分均低于对照组(P﹤0.05)。术后3天,对照组患者QoR-40量表中情绪状态、身体舒适度、心理支持、自理能力、疼痛维度的评分均低于TAP组患者(P﹤0.05)。术后,TAP组患者舒芬太尼用量、PCA输注量、每24小时有效按压次数均明显少于对照组患者(P﹤0.01)。TAP组患者术后24 h内不良反应总发生率低于对照组患者(P﹤0.05)。结论超声下TAP阻滞能够使腹腔镜下行直肠癌根治术的患者维持较稳定的血流状态,减少术后麻醉药物用量,且不增加药物不良反应,有利于术后平稳镇痛。

Objective To investigate the effect of transverse abdominal plane(TAP)block under ultrasound on analgesia and adverse reactions in patients undergoing laparoscopic radical resection of rectal cancer.Method According to the random number table method,80 cases of rectal cancer patients undergoing laparoscopic radical resection were divided into TAP group(n=40)and control group(n=40).The TAP group received transverse abdominal muscle block under the guidance of ultrasound,and the control group was anesthetized routinely.The time of anesthesia,the time of operation,the time of getting out of bed for the first time after operation,the time of exhaust for the first time after operation and the time of hospitalization were compared between the two groups.The mean arterial pressure(MAP),heart rate(HR)and visual analogue scale(VAS)were compared at different time points[before anesthesia(T0),1 hour after operation(T_(1)),12 hours after operation(T_(2)),24 hours after operation(T_(3))and 48 hours after operation(T_(4))].The scores of 40-itemquality of recovery score(QoR-40)were compared between the two groups 1 day before operation and 3 days after operation.The dosage of sufentanil,the amount of patient controlled analgesia(PCA)infusion,effective pressing times per 24 hours and the occurrence of adverse reactions within 24 hours after operation were recorded in the two groups.Result The time of getting out of bed for the first time after operation,the time of exhaust for the first time after operation and the time of hospitalization in the TAP group were shorter than those in the control group(P<0.05).MAP and HR at T_(1) and T_(2) in TAP group were lower than those in control group(P<0.05).The VAS scores at T_(1),T_(2),T_(3) and T_(4) in the TAP group were lower than those in the control group(P<0.05).The scores of emotional state,physical comfort,psychological support,self-care ability and pain dimension of QoR-40 in the TAP group were higher than those in the control group(P<0.05).The dosage of sufentanil,the amount of PCA infusion and effective pressing times per 24 hours in the TAP group were lower than those in the control group(P<0.05).The total incidence rate of adverse reactions within 24 hours after operation in the TAP group was lower than that in the control group(P<0.05).Conclusion The transverse abdominal muscle block under ultrasound can maintain stable blood flow of patients undergoing laparoscopic radical resection of rectal cancer without increasing adverse drug reactions and reducing postoperative anesthetic dosage,which is beneficial to stable postoperative analgesia.