腹横筋膜阻滞在腹腔镜直肠癌低位前切除术后镇痛中的应用

发布时间：2018-07-20 12:43

【摘要】：目的探讨腹横筋膜(transversus abdominis plane,TAP)阻滞在腹腔镜直肠癌低位前切除术后镇痛中的应用价值。方法选择2015年3月~2016年11月北京朝阳医院腹腔镜直肠癌低位前切除术68例,以随机数字表法分为2组。TAP组33例,麻醉插管后在超声引导下以0.375%罗哌卡因20 ml行双侧TAP阻滞;对照组35例,按同样方法注射等剂量生理盐水。比较2组术后2、4、8、12、24 h静态及动态疼痛数字评分(numeric rating scale,NRS),以及术后肠蠕动恢复(有肠鸣音)时间、术后首次下床活动时间、术后住院时间、围手术期治疗费用、术后并发症。结果与对照组相比,TAP组术后恢复肠鸣音早[(28.1±9.8)h vs.(35.6±9.4)h,t=-3.214,P=0.002],术后首次下床早[(1.7±0.6)d vs.(2.0±0.6)d,t=-2.030,P=0.046],术后住院时间短[(7.1±1.2)d vs.(7.8±1.7)d,t=-2.122,P=0.038]。TAP组术后2、4、8、12、24 h静态及动态疼痛NRS均显著低于对照组[2 h静态(3.3±0.8)分vs.(4.0±0.8)分,t=-3.922,P=0.000;4 h静态(2.8±0.9)分vs.(3.5±0.7)分,t=-4.090,P=0.000;8 h静态(2.5±0.6)分vs.(3.1±0.6)分,t=-4.535,P=0.000;12 h静态(2.4±0.6)分vs.(3.0±0.4)分,t=-5.074,P=0.000;24 h静态(2.3±0.7)分vs.(2.7±0.5)分,t=-3.239,P=0.002;2 h动态(4.1±1.0)分vs.(4.9±1.1)分,t=-3.261,P=0.002;4 h动态(3.9±0.8)分vs.(4.5±1.0)分,t=-3.001,P=0.004;8 h动态(3.5±0.8)分vs.(4.2±0.7)分,t=-3.742,P=0.000;12 h动态(3.2±0.8)分vs.(3.7±0.7)分,t=-3.350,P=0.001;24 h动态(2.6±0.7)分vs.(3.3±0.6)分,t=-4.706,P=0.000]。2组术后并发症(恶心、呕吐、肠梗阻、消化道出血、切口感染、肺部感染、心力衰竭)发生率差异无统计学意义(P0.05)。结论 TAP阻滞能为腹腔镜直肠癌低位前切除术提供良好的术后镇痛,有利于术后恢复。
[Abstract]:Objective to explore the application value of transversus abdominis plane (TAP) block in the postoperative analgesia after low anterior resection of rectal cancer. Methods 68 cases of low anterior resection of rectal cancer in Beijing Chaoyang Hospital, November, March 2015, were selected and divided into 2 groups of 33 cases in group.TAP with random digital table method. Under the guidance of 0.375% ropivacaine 20 ml bilateral TAP block, 35 cases in the control group were injected with equal dose of normal saline by the same method. The number of 2,4,8,12,24 h static and dynamic pain digital scores (numeric rating scale, NRS) after operation, and the time of postoperative intestinal peristalsis (with bowel sounds) after operation, the time of the first step after operation, the time of postoperative hospital stay, and the circumference of postoperative hospital stay, were compared in the control group. Compared with the control group, the TAP group recovered early [(28.1 + 9.8) H vs. (35.6 + 9.4) h, t=-3.214, P=0.002], and the first step down to bed early [(1.7 + 0.6) d vs. (2 + 0.6) d, t=-2.030, P=0.046], after operation (7.1 + 1.2) (7.1 + 1.2) (7.8 + 1.7)) after the operation. H static and dynamic pain NRS were significantly lower than the control group [2 h static (3.3 + 0.8) vs. (4 + 0.8), t=-3.922, P=0.000; 4 h static (2.8 + 0.9) vs. (3.5 + 0.7), t=-4.090, P=0.000; 8 h (2.5 + 0.6) divided. S. (2.7 + 0.5), t=-3.239, P=0.002; 2 h dynamic (4.1 + 1) vs. (4.9 + 1.1), t=-3.261, P=0.002; 4 h dynamic (3.9 + 0.8) divided into vs. (4.5 + 1), t=-3.001, P=0.004; 8 h. There was no significant difference in the incidence of postoperative complications (nausea, vomiting, intestinal obstruction, gastrointestinal bleeding, incision infection, pulmonary infection, heart failure) in group P=0.000].2 (P0.05). Conclusion TAP block can provide good postoperative analgesia for laparoscopic low rectal cancer resection and it is beneficial to postoperative recovery.
【作者单位】：首都医科大学附属北京口腔医院麻醉科;首都医科大学附属北京朝阳医院麻醉科;首都医科大学附属北京朝阳医院普外科;
【基金】：国家自然科学基金面上项目(81171025、81371199、81771139)
【分类号】：R614;R735.37

【相似文献】