超声引导腹横肌平面阻滞在腹腔镜胆囊切除术中的应用

Application of Ultrasound-guided Transverse Abdominis Plane Block in Laparoscopic Cholecystectomy

目的:探讨超声引导腹横肌平面阻滞在腹腔镜胆囊切除术中的应用效果。方法:选取2020年1月-2022年12月南昌市第一医院收治的行腹腔镜胆囊切除术的患者60例,用随机数字表法分为对照组和试验组,各30例。两组均给予丙泊酚1.5~2 mg/kg、舒芬太尼0.1~0.2μg/kg、咪达唑仑0.02 mg/kg、阿曲库铵0.2 mg/kg麻醉诱导,试验组行超声引导腹横肌平面阻滞,注射0.25%罗哌卡因10 mL,对照组使用同等剂量生理盐水注射。于切皮前(T0)、切皮时(T_(1))、切皮后15 min(T_(2))、切皮后30 min(T_(3))、术后即刻(T_(4))记录两组平均动脉压(MAP)、心率(HR)、经皮动脉血氧饱和度(SpO_(2));记录两组使用丙泊酚、瑞芬太尼的总量及术后首次排气时间及进食时间;在苏醒后0.5、1、2、6、12、24 h记录两组视觉模拟评分法(VAS)评分;同时记录两组不良反应发生情况。结果:T0时间点,两组MAP、HR水平比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时间点,两组MAP、HR水平呈下降趋势,但试验组MAP、HR均高于对照组(P<0.05);T_(4)时间点,两组MAP、HR水平均较T_(3)时间点升高,且试验组均高于对照组(P<0.05),T0、T_(1)、T_(2)、T_(3)、T_(4)时间点,两组SpO_(2)水平比较,差异均无统计学意义(P>0.05)。试验组术中丙泊酚用量、瑞芬太尼用量均少于对照组,术后首次排气时间、进食时间均短于对照组(P<0.05)。苏醒后各时间点试验组VAS评分均低于对照组(P<0.05)。试验组不良反应发生率(6.67%)低于对照组(26.67%)(P<0.05)。结论:超声引导腹横肌平面阻滞应用于腹腔镜胆囊切除术可减轻血流动力学波动,且具有麻醉药物用量少、术后恢复快、疼痛轻、不良反应发生率低等优势。

Objective:To investigate the application effect of ultrasound-guided transverse abdominis plane block in laparoscopic cholecystectomy.Method:A total of 60 patients undergoing laparoscopic cholecystectomy admitted to the First Hospital of Nanchang from January 2020 to December 2022 were selected and divided into control group and experimental group according to random number table method,with 30 cases in each group.Both groups were given anesthesia induction with 1.5-2 mg/kg Propofol,0.1-0.2μg/kg Sufentanil,0.02 mg/kg Midazolam and 0.2 mg/kg Atracurium.The experimental group received ultrasound-guided transverse abdominis plane block and 10 mL of 0.25%Ropivacaine was injected,while the control group injected the same dose of normal saline.The mean arterial pressure(MAP),heart rate(HR)and percutaneous arterial oxygen saturation(SpO_(2))of the two groups were recorded before skin incision(T0),during skin incision(T_(1)),15 min after skin incision(T_(2)),30 min after skin incision(T_(3))and immediately after operation(T_(4)).The total amount of Propofol and Remifentanil used,the first postoperative exhaust time and eating time in the two groups were recorded.Visual analogue scale(VAS)scores of the two groups were recorded at 0.5,1,2,6,12 and 24 h after awakening,and the occurrence of adverse reactions were recorded in both groups.Result:At T0 time point,there were no significant differences in MAP and HR levels between the two groups(P>0.05).At T_(1),T_(2) and T_(3) time point,the levels of MAP and HR in the two groups showed a downward trend,but those in the experimental group were higher than those in the control group(P<0.05).At T_(4) time point,the levels of MAP and HR in both groups were higher than those at T_(3),and those in the experimental group were higher than those in the control group(P<0.05).There were no significant differences in SpO_(2) levels between the two groups at T0,T_(1),T_(2),T_(3) and T_(4) time point(P>0.05).The dosage of Propofol and Remifentanil in the experimental group were less than those in the control group,and the first postoperative exhaust time and eating time in the experimental group were shorter than those in the control group(P<0.05).The VAS scores of the experimental group were lower than those of the control group at each time point after awakening(P<0.05).The incidence of adverse reactions in the experimental group(6.67%)was lower than that in the control group(26.67%)(P<0.05).Conclusion:The application of ultrasound-guided transverse abdominis plane block in laparoscopic cholecystectomy can reduce hemodynamic fluctuation,and has the advantages of less anesthetic dosage,rapid postoperative recovery,light pain and low incidence of adverse reactions.