不同浓度罗哌卡因联合曲安奈德腹横肌平面阻滞用于肝癌手术术后镇痛的效果评价

Efficacy of Ultrasound-guided Transverses Abdominis Plane Block with Different Concentrations of Ropivacaine combined with Triamcinolone Acetonide for Postoperative Analgesia of Hepatectomy

目的探讨不同浓度罗哌卡因联合曲安奈德超声引导腹横肌平面阻滞在肝癌切除手术术后的镇痛效果。方法选取2020年1月至2021年1月福建医科大学孟超肝胆医院收治的100例行肝癌切除术的患者为研究对象,随机分为5组,试验组按罗哌卡因浓度不同分为0.25%组、0.30%组、0.35%组、0.40%组(罗哌卡因剂量2.5 mg/kg)、C组为空白对照组,每组20例。试验组采用罗哌卡因联合曲安奈德超声引导腹横肌平面阻滞,空白对照组采用曲安奈德超声引导腹横肌平面阻滞。记录5组患者术后静态和动态(咳嗽)视觉模拟疼痛评分(VAS)评分、术后恢复室内舒芬太尼用量及布桂嗪补救镇痛药用量、术后相关并发症及患者满意度。结果与C组比较,试验组舒芬太尼和布桂嗪的消耗量均减少(P<0.05)。与C组比较,试验组的静态VAS评分在0 h、2 h、6 h、12 h、24 h明显降低(P<0.05),在48 h时静态VAS评分无统计学意义(P>0.05)。0.25%组与0.4%组比较,在24 h时静态VAS评分较低(P<0.05)。与C组比较,试验组镇痛泵按压次数减少(P<0.05),满意度较高(P<0.05)。结论0.25%罗哌卡因联合曲安奈德应用于腹横平面阻滞的效果佳,值得临床推广。

Objective To evaluate the efficacy of ultrasound-guided transverses abdominis plane(TAP)block with different concentrations of ropivacaine combined with triamcinolone acetonide after hepatectomy.Methods A total of 100 patients undergoing hepatectomy for liver cancer treated in Meng Chao Hepatobiliary Hospital of Fujian Medical University from January 2020 to January 2021 were randomly divided into five groups.The experimental group was divided into 0.25%group,0.30%group,0.35%group,0.40%group(ropivacaine dosage 2.5 mg/kg)and group C as the blank control group,with 20 cases in each group.The experimental group was treated with ropivacaine combined with triamcinolone acetonide ultrasound-guided transverse abdominal muscle plane block,and the blank control group was treated with triamcinolone acetonide ultrasound-guided transverse abdominal muscle plane block.The postoperative static and dynamic(cough)visual analogue scale(VAS)scores,the dosage of sufentanil and buguizin in postoperative recovery room,postoperative related complications and patient satisfaction were recorded.Results Compared with group C,the consumption of sufentanil and buguizine in the experimental group decreased(P<0.05).Compared with group C,the static VAS score of the experimental group decreased significantly at 0h,2h,6h,12h and 24h(P<0.05),and there was no significant difference at 48h(P>0.05).The static VAS score of 0.25%group was lower than that of 0.4%group at 24 hours(P<0.05).Compared with group C,the pressing times of analgesic pump in the experimental group were reduced(P<0.05),and the satisfaction was higher(P<0.05).Conclusion The ultrasound-guide TAP block with 0.25%ropivacaine combined with triamcinolone acetonide is effective,which is worthy for clinical promotion.