超声引导ESP阻滞联合TAP阻滞对腹腔镜胆囊切除术术后镇痛效果的影响

Effect of Ultrasound-guided ESP Block Combined with TAP Block on Postoperative Analgesia After Laparoscopic Cholecystectomy

目的探讨超声引导竖脊肌平面(ESP)阻滞联合腹横肌平面(TAP)阻滞在腹腔镜胆囊切除术(LC)中的镇痛效果。方法以2020年7月-2022年7月佳木斯市中心医院拟行LC治疗的66例患者为研究对象,依照随机数字表法分为TAP组(33例)与ESP+TAP组(33例)。TAP组于术前行超声引导TAP阻滞,ESP+TAP组则于术前采用超声引导ESP联合TAP阻滞,比较两组围术期各时间点[术前(T0)、气管插管时(T1)、手术30 min(T2)、手术结束时(T3)]的血流动力学指标[心率(HR)、平均动脉压(MAP)]、镇痛效果[疼痛视觉模拟评分(VAS)]、术后镇痛泵按压次数、镇痛泵药液输注总量及麻醉相关并发症。结果ESP+TAP组围术期各时点HR、MAP比较,差异无统计学意义(P>0.05),而TAP组围术期各时点HR、MAP比较,差异有统计学意义(P<0.05),有T1、T2、T3时点HR、MAP均高于ESP+TAP组(P<0.05)。ESP+TAP组术后2、6 h静、动态VAS评分均低于TAP组(P<0.05)。ESP+TAP组术后24 h内镇痛泵按压次数、镇痛泵药液输注总量均少于TAP组(P<0.05)。ESP+TAP组麻醉相关并发症发生率低于TAP组(P<0.05)。结论超声引导ESP联合TAP阻滞可有效维持LC患者的围术期血流动力学稳定,且术后镇痛效果良好,可减少镇痛泵按压次数及其药物用量,降低患者的麻醉并发症风险。

Objective To investigate the analgesic effect of ultrasound-guided erector spinae plane(ESP)block combined with transversus abdominis plane(TAP)block in laparoscopic cholecystectomy(LC).Methods A total of 66 patients who underwent LC in Jiamusi Central Hospital from July 2020 to July 2022 were divided into TAP group(33 patients)and ESP+TAP group(33 patients)according to the random number table method.The TAP group received ultrasound-guided TAP block before operation,and the ESP+TAP group received ultrasound-guided ESP combined with TAP block before operation.The hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]at different time points[preoperative(T0),tracheal intubation(T1),30 min after operation(T2),end of operation(T3)],analgesic effect[visual analogue scale(VAS)],postoperative analgesia pump pressing times,total infusion volume of analgesic pump and anesthesia-related complications were compared between the two groups.Results There were no significant differences in HR and MAP at each time point during the perioperative period in the ESP+TAP group(P>0.05),while there were significant differences in HR and MAP at each time point during the perioperative period in the TAP group(P<0.05),and the HR and MAP at T1,T2 and T3 were higher than those in the ESP+TAP group(P<0.05).The static and dynamic VAS scores of the ESP+TAP group were lower than those of the TAP group at 2 and 6 h after operation(P<0.05).The pressing times of analgesic pump and the total amount of infusion of analgesic pump in ESP+TAP group were less than those in TAP group within 24 h after operation(P<0.05).The incidence of anesthesia-related complications in the ESP+TAP group was lower than that in the TAP group(P<0.05).Conclusion Ultrasound-guided ESP combined with TAP block can effectively maintain the perioperative hemodynamic stability of LC patients,and the postoperative analgesic effect is good.Meanwhile,it can reduce the number of analgesic pump compressions and the dosage of drugs,and reduce the risk of anesthesia complications.