腹横筋膜平面阻滞多模式镇痛在加速康复外科肝包虫病治疗中的应用研究

Study of transversus abdominis plane block as part of multimodal analgesia in enhanced recovery after surgery program for patients with hepatic hydatidosis

目的探讨腹横筋膜平面阻滞多模式镇痛在加速康复外科肝包虫病治疗中的临床效果。方法本研究为随机对照试验研究(注册号为ChiCTR2100053689)。按制订的病例纳入和排除标准前瞻性纳入阿坝藏族羌族自治州人民医院2019年10月至2021年8月期间收治的肝包虫病患者。采取抛硬币正反面奇偶数法分别进入研究组与对照组,研究组采用加速康复外科+腹横筋膜平面阻滞+经静脉患者自控镇痛+曲马多的多模式镇痛治疗,对照组采用加速康复外科+经静脉患者自控镇痛+曲马多的多模式镇痛治疗,比较2组患者的术中及术后情况。结果本研究最终纳入64例患者,其中研究组32例、对照组32例,2组患者的基线资料如性别、年龄、术前肝功能等比较差异无统计学意义(P>0.05)。64例患者的手术均成功,无围手术期死亡病例。2组患者的手术时间、术中出血量及手术方式比较差异均无统计学意义(P>0.05);与对照组比较,研究组术后第1天和第2天的疼痛视觉模拟量表评分更低(P<0.05),术后2 d内曲马多用量及住院费用均更少(P<0.05),术后下床活动时间、术后进食流质饮食时间、术后通气时间及总住院时间均更短(P<0.05),研究组的总并发症发生率低于对照组[28.1%(9/32)比78.1%(25/32),χ2=16.063,P<0.001],并发症综合指数与总住院时间(r=0.941,P<0.001)及住院费用(r=0.958,P<0.001)均呈正相关。结论本研究的初步研究结果提示,腹横筋膜平面阻滞的多模式镇痛在加速康复外科肝包虫病治疗中效果确切,能缩短总住院时间及减少住院费用。

Objective To investigate the clinical effect of transversus abdominis plane(TAP)block as part of multimodal analgesia in enhanced recovery after surgery(ERAS)program for patients with hepatic hydatidosis.Methods This study was a randomized controlled trial(The registration number was ChiCTR2100053689).According to the established inclusion and exclusion criteria,the patients diagnosed with hepatic hydatidosis treated in the People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture from October 2019 to August 2021 were prospectively included.The odd and even by obverse and reverse of coin was adopted to assign into the study group and the control group,respectively.The patients in the study group were treated with ERAS+TAP block+patient controlled intravenous analgesia(PCIA)+tramadol and the patients in the control group were treated with ERAS+PCIA+tramadol.The intraoperative and postoperative statuses of the two groups were compared.Results A total of 64 patients were enrolled in this study,including 32 patients in the study group and 32 patients in the control group.There were no statistical differences in the baseline data such as the age,gender,preoperative complications,preoperative liver function,and liver hydatid type between the two groups(P>0.05).The operations of 64 patients were performed successfully,and there was no perioperative death.There were no statistical differences in the operation time,intraoperative bleeding,and operation mode between the two groups(P>0.05).Compared with the control group,the points of visual analogue scale of postoperative pain on day 1 and 2 were lower(P<0.05),the dosage of tramadol within 2 d after operation and hospitalization expenses were less(P<0.05),and the getting out of bed time,eating liquid diet time,postoperative exhaust time,and total hospital stay were shorter(P<0.05)in the study group.The total complication rate of the study group was lower than that of the control group[28.1%(9/32)vs.78.1%(25/32),χ2=16.063,P<0.001].The comprehensive complication index was positively correlated with the total hospital stay(r=0.941,P<0.001)and hospitalization expenses(r=0.958,P<0.001).Conclusion Preliminary results of this study suggest that multimodal analgesia included TAP block is effective in ERAS,and could shorten hospital stay and reduce hospitalization expenses.