超声引导下腹横肌平面阻滞和切口局麻药浸润在腹腔镜胆囊切除术后镇痛效果的比较

发布时间：2018-03-26 22:16

本文选题：腹横肌平面阻滞　切入点：超声引导　出处：《中国医科大学学报》2017年08期

【摘要】：目的探讨超声引导下腹横肌平面(TAP)阻滞和切口局麻药浸润在腹腔镜胆囊切除术后的镇痛效果。方法将择期行标准三口腹腔镜胆囊切除术的50例患者随机分为2组,每组25例。T组全麻诱导后超声引导下行右侧锁中线平行肋缘入路的TAP阻滞,注入0.25%罗哌卡因40 m L;A组于手术结束时切口用0.5%的罗哌卡因局部浸润。记录入室后、切皮前、气腹3 min的平均动脉压(MAP)及心率(HR),记录手术时间和术中瑞芬太尼的用量。分别于术后0、1、2、6和24 h对患者进行静息状态和咳嗽状态下的疼痛视觉模拟(VAS)评分,记录舒芬和曲马多的用量、恶心呕吐的发生率。结果术中瑞芬太尼的用量T组少于A组(P0.05)。气腹3 min时T组的MAP和HR明显低于A组(P0.05)。静息状态下各时点疼痛VAS评分无统计学差异(P0.05),咳嗽状态下疼痛VAS评分在进入麻醉后苏醒室即刻、1 h和2 h时T组的评分低于A组(P0.05),6 h和24 h时T组和A组间无统计学差异(P0.05)。T组在麻醉后苏醒室内舒芬用量明显少于A组(P0.05)。2组恶心呕吐的发生率无统计学差异(P0.05)。结论锁中线平行肋缘位置的TAP阻滞用于腹腔镜胆囊切除术较切口局麻药浸润对静息状态下的疼痛影响无明显差异,但是可以减轻运动状态下的疼痛,可以减少阿片类药物的用量。
[Abstract]:Objective to investigate the analgesic effect of ultrasound guided abdominal transverse muscle block and incision local anesthetic infiltration after laparoscopic cholecystectomy. Methods 50 patients undergoing standard triple mouth laparoscopic cholecystectomy were randomly divided into two groups. 25 cases in each group were guided by TAP block of right central locking line parallel to the rib after induction of general anesthesia. Group A was injected with 0.25% ropivacaine 40 m LTA at the end of operation with 0.5% ropivacaine local infiltration. The mean arterial pressure (MAPP) and heart rate (HR) of pneumoperitoneum 3 min were recorded, the time of operation and the dosage of remifentanil during operation were recorded. The dosages of sufen and tramadol were recorded. Results during operation, the dosage of remifentanil in group T was less than that in group A (P 0.05). At 3 min after pneumoperitoneum, MAP and HR in group T were significantly lower than those in group A (P 0.05). There was no significant difference in VAS score of pain at different time points in resting state (P 0.05). The VAS score of pain in group T was lower than that in group A at 1 h and 2 h immediately after anesthesia. There was no significant difference between group T and group A at 6 h and 24 h after anesthesia. The dosage of sufen in group T was significantly lower than that in group A at 6 h and 24 h after anaesthesia. The dosage of sufen in group T was significantly lower than that in group A (P 0.05). There was no significant difference in the incidence of nausea and vomiting between the two groups (P 0.05). Conclusion there is no significant difference in the effect of TAP block on the pain in resting state after laparoscopic cholecystectomy compared with local anesthetic infiltration. But it reduces pain during exercise and reduces the amount of opiates used.
【作者单位】：中国医科大学附属盛京医院麻醉科;
【基金】：辽宁省社会发展攻关计划(2012225021)
【分类号】：R614

【相似文献】