TAPB联合PCIA在强直性脊柱炎截骨矫形手术术后镇痛的运用

Application of transversus abdominis plane block combined with patient⁃controlled intravenous analgesia for postoperative analgesia in ankylosing spondylitis patients treated with pedicle subtraction osteotomy

目的探讨单次腹横肌平面阻滞(transversus abdominis plane block,TAPB)联合患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)用于强直性脊柱炎(ankylosing spondylitis,AS)截骨矫形手术术后镇痛的效果。方法40例行截骨矫形手术的AS患者,采用数字随机法分为2组(每组20例):TAPB联合PCIA组(T组)和单纯PCIA组(P组)。P组患者手术结束采用单纯PCIA镇痛,T组患者在P组基础上联合单次TAPB进行镇痛。观察两组患者术后2 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、48 h(T_(5))的VAS疼痛评分,术后24 h内PCIA按压情况及镇痛药物追加情况;记录两组患者术后24 h不良反应发生情况;记录两组患者术前和术后1 d焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS)评分。结果T组患者术后T_(1)、T_(2)、T_(3)、T_(4)、T_(5)的VAS疼痛评分低于P组(P<0.05);T组患者术后24 h内PCIA按压比例低于P组(P<0.05);T组患者术后追加镇痛药物使用比例低于P组(P<0.05);手术前两组患者的SAS和SDS评分差异无统计学意义(P>0.05),术后1 d P组患者的SAS和SDS评分较术前上升(P<0.05),术后1 d T组患者SAS、SDS评分均低于P组(P<0.05);两组患者术后并发症发生率差异无统计学意义(P>0.05)。结论单次TAPB联合PCIA可安全应用于截骨矫形手术AS患者,减轻术后疼痛,缓解术后焦虑抑郁情绪,有利患者康复。

Objective To observe the clinical effectiveness of single transversus abdominis plane block(TAPB)combined with patient‑controlled intravenous analgesia(PCIA)for postoperative analgesia in ankylosing spondylitis(AS)patients treated with pedicle subtraction osteotomy.Methods A total of 40 AS patients undergoing pedicle subtraction osteotomy were selected.Accord‑ing to the random number table method,they were divided into two groups(n=20):a TAPB combined with PCIA group(group T)and a PCIA group(group P).Group P was given postoperative PCIA alone,while group T received simply TAPB combined with postoperative PCIA.Their Visual Analogue Scale(VAS)scores were recorded in both groups 2 h after surgery(T_(1)),6 h after surgery(T_(2)),12 h after surgery(T_(3)),and 24 h after surgery(T_(4)).The effective pressing times of PCIA and the use of rescue analgesia 24 h after surgery were re‑corded.The incidences of adverse reactions were also recorded in both groups 24 h after surgery.The scores of Self‑Rating Anxiety Scale(SAS)and Self‑Rating Depression Scale(SDS)were evaluated in both groups before surgery and 1 day after surgery were record‑ed.Results Patients in group T presented remarkably lower VAS scores than those in group P at T_(1),T_(2),T_(3),T_(4),and T_(5)(P<0.05).Pa‑tients in group T showed a significantly reduced percentage of pressing PCIA 24 h after surgery,compared with group P(P<0.05).Pa‑tients in group T showed a significantly reduced percentage of rescue analgesia,compared with group P(P<0.05).Before surgery,there was no significant difference in SAS and SDS scores between the two groups(P>0.05).One day after surgery,the SAS and SDS scores of patients in group P increased compared with those before surgery(P<0.05).One day after surgery,the scores of SAS and SDS in group T were lower than those in group P(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusions The combination of simple TAPB and PCIA can be safely applied in pedicle sub‑traction osteotomy for AS patients,which weakens postoperative pain,relieves anxiety and depression after surgery,and fastens recov‑ery.