超声引导下多点肋缘下腹横肌平面阻滞在开腹胃癌根治术中的应用

发布时间：2018-04-28 17:11

本文选题：超声 + 腹横肌平面阻滞　；参考：《临床麻醉学杂志》2017年12期

【摘要】：目的观察双侧多点肋缘下腹横肌平面阻滞(transversus abdominis plane block,TAP)对开腹胃癌根治术患者术后镇痛效果的影响。方法择期全麻下行开腹胃癌根治术患者60例,男35例,女25例,年龄50~70岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。全麻诱导成功后,超声引导下行双侧肋缘下多点腹横肌平面阻滞,两组患者分别注入0.5%罗派卡因40ml(研究组)或等量生理盐水(对照组)。手术结束患者清醒拔管后被推入PACU,患者离开PACU之前连接静脉自控镇痛泵。记录拔管后2、6、12、24和48h的疼痛VAS评分,记录术中舒芬太尼、瑞芬太尼及血管活性药物的总用量,术后镇痛泵按压次数及舒芬太尼的总用量。结果术后6、12、24h,研究组VAS评分明显低于对照组(P0.05)。研究组术中舒芬太尼、瑞芬太尼和血管活性药物的总用量,术后镇痛泵按压次数,及术后舒芬太尼的总用量均明显少于对照组(P0.05)。结论腹横肌平面阻滞通过阻滞前腹壁腹横肌平面的周围神经,为开腹胃癌根治术患者提供良好的术后镇痛。
[Abstract]:Objective To observe the effect of transversus abdominis plane block (TAP) on postoperative analgesia in patients with laparotomy for radical gastrectomy. Methods 60 patients with radical gastrectomy under general anesthesia, 35 male, 25 female, 50~70 years old, ASA I or grade II, were randomly divided into two groups, 30 cases in each group. After successful guidance, ultrasound guided multipoint abdominal transverse block under bilateral ribbed border. The two groups were injected with 0.5% ropicine 40ml (Study Group) or equal amount of saline (control group). After the operation, patients were pushed into PACU after sober extubation, and the patients were connected to the intravenous self controlled analgesia pump before leaving PACU. The pain V of 2,6,12,24 and 48h after extubation was recorded. AS score, the total dosage of sufentanil, remifentanil and vasoactive drugs, the number of press times and the total amount of sufentanil after operation. Results after the operation, the VAS score of the study group was significantly lower than that of the control group (P0.05). The total dosage of sufentanil, rifentanil and vasoactive drugs in the study group and the pressure of postoperative analgesia pump were pressed. The number of times, and the total amount of sufentanil after operation were significantly less than that of the control group (P0.05). Conclusion the horizontal block of the abdominal transverse muscle can provide good postoperative analgesia for the patients with open stomach cancer by blocking the peripheral nerves of the anterior abdominal transverse muscle plane.

【作者单位】：解放军第148中心医院麻醉科;
【分类号】：R614;R735.2

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