超声引导腹横肌平面阻滞在直肠癌加速康复外科手术中的应用

摘要

目的：观察超声引导腹横肌平面（TAP）阻滞联合静脉自控镇痛对腹腔镜直肠癌术后镇痛及患者恢复情况的影响，探讨其在直肠癌加速康复外科手术中的临床意义。方法择期行腹腔镜直肠癌手术患者60例，性别不限，ASAⅠ或Ⅱ级，年龄30～65岁，体质量45～90 kg，采用随机数字表法均分为两组（n ＝30）：A 组：全身麻醉后切皮前超声引导0．375％罗哌卡因行双侧腹横肌平面阻滞，每侧20 mL，术毕行静脉自控镇痛；B 组：全身麻醉后切皮前不做任何躯干神经阻滞处理，术毕行静脉自控镇痛。观察并记录患者术后1 h（T0）、4 h （T1）、8 h（T2）、12 h（T3）、24 h（T4）、48 h（T5）时疼痛视觉模拟评分（VAS），第1次使用补救性非甾体类镇痛药时间和术后患者满意度，及患者胃肠道恢复时间、下床活动时间、该阻滞部位腹腔内脏器损伤、穿刺部位感染、血肿等并发症的发生情况。结果两组患者年龄、性别、体质量、ASA 分级及手术时间比较无统计学意义。与 B组比较，T0～T4时 A 组疼痛 VAS 评分明显降低（P ＜0．05）；A 组患者术后第1次使用补救性非甾体类镇痛药时间[（11．7±1．3）h]较 B 组[（4．3±1．2）h]明显延长（P ＜0．05）；A 组术后满意度（93．3％）比 B 组（70．0％）显著提高（P ＜0．05）；两组患者术后胃肠功能恢复时间和下床活动时间差异均无统计学意义；A 组无一例患者出现阻滞部位腹腔内脏器损伤、穿刺部位感染及血肿等并发症。结论超声引导腹横肌平面阻滞联合静脉自控镇痛基本能满足腹腔镜直肠癌术后镇痛的需要，减少术后镇痛药物使用。%Objective To assess the effect of transversus abdominis plane (TAP)block combined with patient-controlled intravenous analgesia (PCIA)on enhanced recovery after surgery at laparoscopic-assisted surgery for colorec-tal cancer.Methods Sixty ASA physical statusⅠor Ⅱ patients scheduled for laparoscopic-assisted surgery for colorec-tal cancer (both sexes,aged 20-65 yr,weighing 45-90 kg)were randomly divided into 2 groups (n =30)using a ran-dom number table.Group A adopted ultrasound-guided bilateral TAP block with PCIA and 20ml 0.375% ropivacaine and group B accepted only PCIA without any local analgesic procedure.Postoperative VAS score at five time points were compared between the two groups.First use of non-steroidal analgesic and satisfaction of anesthesia procedure were re-corded.Gastrointestinal recovery time and complications were recorded.Results Compared with group B,the time of anesthesia procedure was significantly shorter,and working time was significantly shortened and the analgesia time was obviously prolonged in group A (P <0.05).VAS score of group A was less than that of group B control at T0-T3 (P <0.05).Pain caused by the applied tourniquet and frequency of required non-steroidal analgesic in group A were signifi-cantly lower than those in group B (P <0.05).Satisfaction of anesthesia in group A was significantly more than that in group B (P <0.05).There was no complication in both groups.Conclusion Ultrasound-guided TAP block with PCIA can provided safe post-operative analgesia for laparoscopic-assisted surgery for colorectal cancer with reduced opioid con-sumption.