超声引导下腹横肌平面阻滞在腹腔镜手术中的应用价值

Application value of ultrasound-guided transversus abdominis plane block in laparoscopic surgery

目的探讨超声引导下腹横肌平面(transversus abdominis plane,TAP)阻滞联合全凭静脉麻醉在腹腔镜手术中的应用价值。方法选取2020年6月至2021年12月于瑞安市人民医院行全身麻醉腹腔镜手术的94例患者作为研究对象,采用随机数字表法分为观察组和对照组,每组各47例。两组患者均行全凭静脉麻醉,观察组患者联合超声引导下TAP阻滞。评估两组患者入室后、切皮前、切皮后、气腹结束后的血流动力学[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)]、应激反应[血浆去甲肾上腺素(norepinephrine,NE)],比较两组患者的术后疼痛视觉模拟评分(visual analogue scale,VAS)、术后恢复情况,记录两组患者的不良反应发生率。结果入室后、切皮前、切皮后、气腹结束后,对照组患者的HR持续升高(P<0.05),观察组患者的HR先降低再升高(P<0.05),两组患者的MAP先降低再升高(P<0.05),NE水平均持续上升(P<0.05);观察组患者切皮后、气腹结束后的HR、NE水平均显著低于同期对照组,MAP均显著高于同期对照组(P<0.05);术后至病房、术后4h、术后24h,观察组患者的VAS评分持续下降(P<0.05),对照组患者的VAS评分先上升后下降(P<0.05),观察组患者术后4h、术后24h的VAS评分均显著低于同期对照组(P<0.05);两组患者的术后意识恢复时间、肛门排气时间、下床时间、不良反应发生率比较,差异均无统计学意义(P>0.05)。结论超声引导下TAP阻滞应用于腹腔镜手术有利于术中稳定循环、减少应激,减轻术后疼痛,安全性较高。

Objective To explore the value of ultrasound-guided transversus abdominis plane(TAP)block combined with total intravenous anesthesia in laparoscopic surgery.Methods From June 2020 to December 2021,94 patients undergoing laparoscopic surgery under general anesthesia in Ruian People’s Hospital were divided into observation group and control group with 47 cases in each group by random number table method.Total intravenous anesthesia was performed in both groups and patients in observation group were combined with ultrasound-guided TAP block.The hemodynamics[heart rate(HR),mean arterial pressure(MAP)]and stress response[plasma norepinephrine(NE)]were evaluated in the two groups after entering the operating room,before skin incision,after skin incision and after the end of pneumoperitoneum.The visual analogue scale(VAS)and postoperative recovery were compared between the two groups,and the incidence rates of adverse reactions in the two groups were recorded.Results After entering the operating room,before skin incision,after skin incision and after the end of pneumoperitoneum,the HR of control group continued to increase(P<0.05),the HR of observation group decreased first and then increased(P<0.05),MAP in both groups decreased first and then increased(P<0.05),and NE continued to increase(P<0.05).After skin incision and the end of pneumoperitoneum,the levels of HR and NE in observation group were significantly lower than those in control group,MAP was significantly higher than those in control group(P<0.05).From postoperative to the ward,4 hours and 24 hours after operation,the VAS score of patients in observation group continued to decrease(P<0.05),while the VAS score of patients in control group increased first and then decreased(P<0.05).The VAS scores of the observation group at 4 hours and 24 hours after operation were significantly lower than those of control group(P<0.05).There were no significant differences in the recovery time of consciousness,anal exhaust time,getting out of bed time,and incidence of adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided TAP block in laparoscopic surgery is beneficial to intraoperative circulation stability,reduce stress,reduce postoperative pain,and has high safety.