超声引导腹横肌平面阻滞用于腹腔镜胆囊切除术后镇痛

发布时间：2018-05-16 01:37

  本文选题：超声引导 + 腹横肌平面　； 参考：《山西医科大学》2014年硕士论文

【摘要】：目的：评价超声引导腹横肌平面阻滞用于腹腔镜胆囊切除患者的术后镇痛效果。 方法：60例腹腔镜胆囊切除患者，随机分为两组，每组30例，分别为腹横肌平面阻滞组(transversus abdominis plane，TAP组)和患者自控静脉镇痛组（patient-controlled intravenousanalgesia group，PCIA组）。两组患者均采用静吸复合全身麻醉。手术结束后，TAP组接受超声引导腹横肌平面阻滞，每点注射0.25盐酸罗哌卡因注射液20ml，PCIA组采用1g/ml枸橼酸舒芬太尼注射液静脉自控镇痛。应用视觉模拟评分(visual analogue scale，，VAS）法评估疼痛强度和术后恶心呕吐（post-operative nausea and vomiting，PONV）程度。VAS≥4分，给予镇痛补救药物氟比洛芬酯注射液50mg镇痛，出现中度及以上程度PONV，静脉注射盐酸甲氧氯普胺注射液10mg止吐。记录手术时间，麻醉诱导、麻醉维持药物用量；于出恢复室时、术后6h时、术后24h时记录静息VAS评分；比较两组患者出恢复室时、术后6h时、术后24h时疼痛强度；记录两组患者恢复室内、出恢复室-术后6h、术后6h-24h三个时段镇痛补救例数；比较两组患者PONV、呼吸抑制、皮肤瘙痒等不良反应的发生率；观察TAP组局麻药中毒、腹腔内脏器损伤等腹横肌平面阻滞操作并发症的发生率。 结果：两组患者手术时间、麻醉诱导用药量、麻醉维持用药量差异无统计学意义；TAP组镇痛效果显著，出恢复室时、术后6h时、术后24h时，两组患者疼痛强度差异无统计学意义；恢复室内、出恢复室-术后6h、术后6h-24h三个时段，两组镇痛补救发生率差异无统计学意义。术后24小时内，与PCIA组相比，TAP组PONV发生率明显减少（p0.05），差异有统计学意义。两组患者术后均未见呼吸抑制，皮肤瘙痒等药物不良反应，TAP组未发现腹腔内脏器损伤、局麻药中毒等操作并发症。 结论：超声引导TAP阻滞具有良好的腹腔镜胆囊切除术后镇痛作用，并可降低术后恶心呕吐发生率，是一项安全、有效、并发症少的术后镇痛措施。
[Abstract]:Objective: to evaluate the analgesic effect of abdominal transverse muscle block guided by ultrasound in patients undergoing laparoscopic cholecystectomy. Methods Sixty patients with laparoscopic cholecystectomy were randomly divided into two groups: 30 patients in each group (n = 30) and patient-controlled intravenousanalgesia group (n = 30). Both groups were treated with intravenous inhalation combined with general anesthesia. After the operation, the tap group received ultrasound guided abdominal transverse muscle block, and 20 ml ropivacaine hydrochloride injection was injected into each point. PCIA group received 1g/ml citrate sufentanil injection for patient-controlled analgesia. Visual analogue scale (VAS) was used to evaluate the pain intensity and the degree of postoperative nausea and vomiting post-operative nausea and vomiting.VAS 鈮

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