超声引导下腹横肌平面阻滞复合喉罩全身麻醉在腹腔镜胆囊切除患者中的应用

Application of Ultrasound-guided Transversus Abdominis Plane Block Combined with Laryngeal Mask General Anesthesia in Patients with Laparoscopic Cholecystectomy

目的:观察超声引导下腹横肌平面阻滞(TAPB)复合喉罩全身麻醉在腹腔镜胆囊切除患者中的应用效果。方法:选取2019年10月-2021年10月在北京市昌平区中医医院接受腹腔镜胆囊切除术的100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,各50例。对照组术中采用喉罩全身麻醉,观察组采用超声引导下TAPB复合喉罩全身麻醉,两组均于术后采用自控静脉镇痛。比较两组麻醉诱导后5 min(T_(1))、切皮时(T_(2))、胆囊切除时(T_(3))、术毕时(T_(4))的心率(HR)、平均动脉压(MAP);比较两组麻醉苏醒后6 h(T_(5))、12 h(T_(6))、24 h(T_(7))、48 h(T_(8))时疼痛程度[视觉模拟评分法(VAS)];比较两组麻醉药物使用剂量及术后48 h内不良反应发生情况。结果:两组T_(2)、T_(3)、T_(4)的HR均较T_(1)加快,MAP均较T_(1)升高,并且T_(3)、T_(4)的HR、MAP均高于T_(2),差异均有统计学意义(P<0.05);观察组T_(2)、T_(3)、T_(4)的HR均较对照组慢,MAP均较对照组低,差异均有统计学意义(P<0.05)。两组VAS评分在T_(6)~T_(8)处于升高阶段,与T_(5)比较,T_(6)、T_(7)、T_(8)的VAS评分均较高,T_(7)、T_(8)的VAS评分均高于T_(6),T_(8)的VAS评分高于T_(7),差异均有统计学意义(P<0.05);观察组T_(6)~T_(8)的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组丙泊酚、瑞芬太尼、舒芬太尼使用剂量均少于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下行TAPB并复合喉罩全身麻醉用于腹腔镜胆囊切除患者中可减轻应激反应,利于维持血流动力学稳定,还可减轻术后疼痛,减少麻醉药物使用剂量。

Objective:To observe the application effect of ultrasound-guided transversus abdominis plane block(TAPB)combined with laryngeal mask general anesthesia in patients with laparoscopic cholecystectomy.Method:A total of 100 patients who underwent laparoscopic cholecystectomy in Beijing Changping Hospital of Chinese Medicine from October 2019 to October 2021 were selected as the research subjects.They were divided into observation group and control group by random number table method,with 50 cases in each group.The control group was treated with laryngeal mask general anesthesia,and the observation group was treated with ultrasoundguided TAPB combined with laryngeal mask general anesthesia,patient controlled intravenous analgesia was used in both groups.Heart rate(HR)and mean arterial pressure(MAP)were compared between the two groups at 5 minutes after anesthesia induction(T_(1)),skin incision(T_(2)),cholecystectomy(T_(3)),and the end of operation(T_(4));the pain degree[visual analogue scale(VAS)]at 6 h(T_(5)),12 h(T_(6)),24 h(T_(7))and 48 h(T_(8))after anesthesia awakening was compared between the two groups;the dosage of narcotic drugs and adverse reactions within 48 hours after operation were compared between the two groups.Result:The HR and MAP of T_(2),T_(3),and T_(4) in both groups increased compared to T_(1),and the HR and MAP of T_(3) and T_(4) were higher than those of T_(2),the differences were statistically significant(P<0.05).The HR of T_(2),T_(3),and T_(4) in the observation group were slower than those in the control group,and the MAP were lower than those in the control group,the differences were statistically significant(P<0.05).The VAS scores of the two groups were in an increasing stage from T_(6) to T_(8),compared with T_(5),the VAS scores of T_(6),T_(7),and T_(8) were all higher,and the VAS scores of T_(7) and T_(8) were higher than those of T_(6),the VAS score of T_(8) was higher than that of T_(7),the differences were statistically significant(P<0.05).The VAS scores of T_(6)-T_(8) in the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).The dosage of Propofol,Remifentanil and Sufentanil in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).There was no statistical significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided TAPB combined with laryngeal mask general anesthesia in patients with laparoscopic cholecystectomy can reduce stress response,maintain hemodynamic stability,reduce postoperative pain and reduce the dosage of narcotic drugs.