腹横肌平面神经阻滞联合肺保护性通气对肥胖患者减重手术的肺保护作用

The lung protection effect of transverse abdominal muscle plane nerve block combined with lung protective ventilation on obese patients undergoing bariatric surgery

目的探讨腹横肌平面神经阻滞(TAPB)联合肺保护性通气对肥胖患者减重手术的肺保护作用。方法选择2021年1-8月新疆维吾尔自治区人民医院收治的择期全身麻醉下行减重手术的肥胖患者78例作为研究对象,按随机数字表法分为3组:传统通气组(对照组)、肺保护性通气组(肺保护组)和TAPB联合肺保护性通气组(联合组),各26例。比较3组患者一般资料,气腹前10 min(T_(1))、气腹后30 min(T_(2))、气腹后1 h(T_(3))和气腹结束10 min(T_(4))的动态肺顺应性(Cdyn)、静态肺顺应性(Cst)、驱动压和氧合指数,术前、气管导管拔除后10 min、术后4 h和术后24 h肺超声评分(LUS),术后肺部并发症(PPCs)发生率。结果联合组患者下床活动时间、住院时间、舒芬太尼追加量、瑞芬太尼用量和术后各时点疼痛视觉模拟量表评分均短于/低于对照组和肺保护组(均P<0.05)。T_(2)、T_(3)、T_(4)时点,肺保护组和联合组Cdyn、Cst、氧合指数高于对照组,且联合组高于肺保护组,联合组驱动压低于对照组和肺保护组(均P<0.05)。3组患者气管导管拔除后10 min、术后4 h和术后24 h时LUS均高于术前(均P<0.05)。气管导管拔除后10 min联合组和肺保护组LUS均低于对照组,术后4、24 h联合组LUS均低于对照组和肺保护组(均P<0.05)。联合组PPCs总发生率低于对照组和肺保护组[3.8%(1/26)比42.3%(11/26)、30.8%(8/26)](P=0.002)。结论TAPB联合肺保护性通气可改善肥胖患者减重手术围手术期肺通气,具有肺保护作用,效果优于单独应用肺保护通气策略。

Objective To investigate the lung protection effect of transverse abdominal muscle plane nerve block(TAPB)combined with lung protective ventilation(LPV)on obese patients undergoing bariatric surgery.Methods From January to August 2021,78 obese patients treated with bariatric surgery under selective general anesthesia in Xinjiang Uygur Autonomous Region People′s Hospital were selected as the research subjects.They were divided into three groups according to random number table method,including traditional ventilation group(control group),LPV group(lung protection group)and TAPB combined LPV group(joint group),with 26 cases in each group.The general data,dynamic lung compliance(Cdyn),static lung compliance(Cst),driving pressure and oxygenation index at 10 min before pneumoperitoneum(T_(1)),30 min after pneumoperitoneum(T_(2)),1 h after pneumoperitoneum(T_(3))and 10 min after the end of pneumoperitoneum(T_(4)),lung ultrasound score(LUS)before operation,10 min after tracheal catheter extraction,4 and 24 h after operation,and the incidence of postoperative pulmonary complications(PPCs)among three groups were compared.Results The time of getting out of bed,length of stay,the additional amount of sufentanil,the amount of remifentanil and the score of pain visual analogue scale at each time point after operation in the joint group were shorter/lower than those in the control group and the lung protection group(all P<0.05).At the time points of T_(2),T_(3)and T_(4),the Cdyn,Cst and oxygenation index in the lung protection group and the joint group were higher than those in the control group,the joint group was higher than that in the lung protection group,and the driving pressure in the joint group was lower than that in the control group and the lung protection group(all P<0.05).LUS at 10 min after tracheal catheter extraction,4 and 24 h after operation in the three groups were higher than that before operation(all P<0.05).The LUS in the joint group and the lung protection group were lower than that in the control group at 10 min after tracheal catheter extraction,and the LUS in the joint group were lower than those in the control group and the lung protection group at 4 and 24 h after the operation(all P<0.05).The total incidence of PPCs in the joint group was lower than that in the control group and the lung protection group[3.8%(1/26)vs 42.3%(11/26),30.8%(8/26)](P=0.002).Conclusions TAPB combined with LPV can improve perioperative lung ventilation in obese patients undergoing bariatric surgery,with lung protection effect.It is better than the single application of LPV strategy.