盐酸羟考酮或吗啡静脉自控镇痛泵联合超声引导下腹横肌平面阻滞在胃肠肿瘤根治术后的镇痛效果

Analgesic efficacy of patient-controlled intravenous analgesia oxycodone hydrochloride or morphine combined with ultrasound-guided transversus abdominis plane block in patients with gastrointestinal neoplasms after radical resection

目的探讨盐酸羟考酮或吗啡静脉自控镇痛泵(PCIA)联合超声引导下腹横机平面阻滞(TAP)在胃肠肿瘤根治术后的镇痛效果。方法选取2016年1月至2017年1月间上海闵行区中心医院收治的120例行胃肠肿瘤根治术患者,采用随机数表法分为A、B、C三组,每组40例。A组患者采用彩超引导下双侧TAP阻滞联合盐酸羟考酮PCIA治疗,B组患者采用彩超引导下双侧TAP阻滞联合吗啡PCIA治疗,C组患者采用彩超引导下双侧TAP阻滞联合生理盐水(安慰剂) PCIA治疗。观察三组患者术后2h、6h、12h、24h和48h静息和咳嗽状态下的视觉模拟评分法(VAS)评分、术中舒芬太尼用量、术后24h补救镇痛率、48h静脉自控镇痛泵(PCIA)有效按压次数及用药不良反应。结果 A组患者2h、6h、12h、24h和48h静息和咳嗽状态下VAS评分均低于B组和C组,且B组患者不同状态下不同时间点与C组比较,差异均有统计学意义(均P <0. 05)。三组患者术中舒芬太尼用量比较,差异无统计学意义(P> 0. 05)。C组患者24h补救镇痛率均高于A组和B组,差异有统计学意义(P <0. 05),A组低于B组,但差异无统计学意义。C组患者48h PCIA有效按压次数均少于A组和B组,且A组少于B组,差异均有统计学意义(均P <0. 05)。三组患者用药不良反应比较,差异均无统计学意义(均P> 0. 05)。A组患者恶心呕吐发生率高于C组,差异有统计学意义(P <0. 05)。结论超声引导下双侧TAP阻滞联合盐酸羟考酮PCIA应用于胃肠肿瘤根治术后患者镇痛效果确切,且无明显用药不良反应。

Objective To observe the analgesic efficacy of patient-controlled intravenous analgesia( PCIA) oxycodone hydrochloride or morphine combined with ultrasound-guided transversus abdominis plane( TAP) block in patients with gastrointestinal neoplasms after radical resection. Methods From January 2016 to January 2017,120 patients undergoing radical resection for gastrointestinal tumors at Shanghai Minhang District Central Hospital were selected and divided into three groups according to random digital table with 40 patients in each group. Group A was treated with bilateral TAP block combined with PCIA oxycodone hydrochloride guided by color Doppler ultrasound. Group B was treated with bilateral TAP block combined with PCIA morphine guided by color Doppler ultrasound. Group C was treated with bilateral TAP block combined with PCIA saline( placebo) guided by color Doppler ultrasound. The visual analogue score( VAS) was observed at 2,6,12,24 and 48 h after the operation,and under cough state was observed. The dosage of sufentanil,the rate of relief analgesia at 24 h after operation,the effective times of PCIA pressing and the adverse drug reactions at 48 h after operation were also observed. Results The VAS scores at 2,6,12,24 and 48 h after the operation and under cough state were lower in group A than in group B and group C. There was significantly difference in VAS scores between group B and group C at different time points( all P < 0. 05). There was no statistically significant difference in the he dosage of sufentanil,among the three groups( P > 0. 05). The rate of relief analgesia at 24 h after operation was higher in group C than in group A and group B( all P < 0. 05). Although the rate of relief analgesia at 24 h after operation was lower in group A than in group B,the difference was not statistically significant( P > 0. 05). The number of effective times of PCIA pressing at 48 h after operation was significantly less in group C than in group A and group B with group A less than group B( all P < 0. 05). There was no significant difference in the incidence of adverse drug reactions among the three groups( P > 0. 05). The incidence of nausea and vomiting in group A is higher than that in group C( P < 0. 05). Conclusion Ultrasound-guided bilateral TAP block combined with oxycodone hydrochloride PCIA was effective in postoperative analgesia of gastrointestinal neoplasms,and there was no obvious adverse drug reaction.