超声引导下连续腹横肌平面阻滞联合纳布啡对妇科开腹手术患者术后早期恢复质量的影响

Effect of ultrasound guided continuous transverse abdominal muscle block combined with Nalbuphine on the early recovery quality of patients after gynecologic laparotomy

目的探讨超声引导下连续腹横肌平面阻滞联合纳布啡对妇科开腹手术患者术后早期恢复质量的影响。方法选取2021年8月至2022年9月江西省萍乡市妇幼保健院麻醉科收治的60例妇科开腹手术患者作为研究对象,按随机数字表法分为对照组(30例)与观察组(30例),L组采用麻醉诱导后给予超声引导下连续腹横肌平面阻滞,术毕采用舒芬太尼复合纳布啡静脉自控镇痛(PCIA),C组仅术毕采用舒芬太尼复合纳布啡PCIA。比较两组患者术中麻醉镇痛药物用量、术后早期恢复质量(术后疼痛情况、术后自主呼吸恢复时间、苏醒时间、拔管时间、24 h内镇痛泵自控次数)以及不良反应发生率的差异。结果L组术中丙泊酚用量、瑞芬太尼用量均少于C组,差异有统计学意义(P<0.05)。L组术后2、6、12、24 h静息时和咳嗽时视觉模拟评分(VAS)均低于C组,差异有统计学意义(P<0.05)。L组术后自主呼吸恢复时间、苏醒时间、拔管时间均短于C组,24 h内镇痛泵自控次数少于C组,差异有统计学意义(P<0.05)。L组不良反应总发生率低于C组,差异有统计学意义(P<0.05)。结论超声引导下连续腹横肌平面阻滞联合纳布啡PCIA能够提高麻醉镇痛效果,减少术中麻醉镇痛药物用量,提高术后早期恢复质量,降低不良反应发生率,值得临床推荐。

Objective To investigate the effect of ultrasound guided continuous transverse abdominal muscle block combined with Nalbuphine on the early recovery quality of patients after gynecologic laparotomy.Methods From August 2021 to September 2022,60 patients with gynecologic laparotomy admitted to the Department of Anesthesiology of Pingxiang Maternity and Care were selected as the research subjects.They were divided into the control group(30 cases)and the observation group(30 cases)according to random number table method.Group L was given ultrasound guided continuous transverse abdominal muscle plane block after anesthesia induction,and used Sufentanil combined with Nalbuphine patient-controlled intravenous analgesia(PCIA)after the operation,group C was treated with Sufentanil combined with Nalbuphine PCIA only after operation.The differences in the amount of anesthetic and analgesic drugs used during the operation,the quality of early recovery after the operation(postoperative pain,recovery time of spontaneous respiration,recovery time,extubation time,self-control times of analgesia pump within 24 hours)and the incidence of adverse reactions between the two groups were compared.Results The dosage of Propofol and Remifentanil in group L were less than those in group C,the differences were statistically significant(P<0.05).The visual analogue score(VAS)of resting and coughing at 2,6,12,24 h after operation in group L were lower than those in group C,the differences were statistically significant(P<0.05).The recovery time of spontaneous respiration,awakening time and extubation time of group L were shorter than those of group C,and the number of self-control of analgesia pump within 24 hours was less than that of group C,the differences were statistically significant(P<0.05).The total incidence of adverse reactions in group L was lower than that in group C,with statistically significant difference(P<0.05).Conclusion Ultrasound guided continuous transversus abdominal plane block combined with Nalbuphine PCIA can improve the effect of anesthesia and analgesia,reduce the amount of anesthetic and analgesic drugs during the operation,improve the quality of early recovery after the operation,and reduce the incidence of adverse reactions,which is worthy of clinical recommendation.