摘要目的 评价超声引导腹横肌平面阻滞(TAPB)对全麻下原位肝移植术病人术后镇痛效果的影响.方法 择期行改良背驮式原位肝移植术病人40例,性别不限,体重指数18 ～ 24 kg/m2,年龄18～64岁,ASA分级Ⅲ-V级,采用随机数字表法分为2组(n=20):TAPB联合全麻组(TAPB-GA组)和全麻组(GA组).TAPB-GA组在诱导后行超声引导下双侧肋缘下人路两点TAPB,每点注入混合药:0.33％罗哌卡因15 ml+0.5％地塞米松0.5 ml.GA组每点注入生理盐水15.5 ml.2组术后使用舒芬太尼2μg/kg PCIA,采用静脉注射舒芬太尼5μg/行补救镇痛,维持术后48 h内VAS评分≤3分.记录术中瑞芬太尼用量和拔除气管导管时间.记录术后48 h内舒芬太尼补救镇痛用量、恶心呕吐、皮肤瘙痒和呼吸抑制的发生情况.结果 与GA组比较,TAPB-GA组术中瑞芬太尼用量、术后48h内舒芬太尼补救镇痛用量减少,气管导管拔管时间缩短,术后恶心呕吐、皮肤瘙痒、呼吸抑制发生率降低(P＜0.05).结论 超声引导TAPB用于全麻下原位肝移植术病人时术后镇痛效果好,不良反应发生少.

abstractsObjective To evaluate the effect of ultrasound-guided transverse abdominal plane block (TAPB) on postoperative analgesia in patients undergoing orthotopic liver transplantation under general anesthesia.Methods Forty American Society of Anesthesiologists physical status Ⅲ-V patients,with body mass index of 18-24 kg/m2,aged 18-64 yr,undergoing elective modified piggy-back orthotopic liver transplantation,were divided into 2 groups (n =20 each) by a random number table method:TAPB combined with general anesthesia group (TAPB-GA group) and general anesthesia group (GA group).In TAPB-GA group,two-point TAPB was performed below bilateral costal margins under ultrasound guidance after induction of general anesthesia,and a mixture of 0.33％ ropivacaine 15 ml plus 0.5％ dexamethasone 0.5 ml was injected into each point.The equal volume of normal saline was injected into each point instead in group GA.Patient-controlled intravenous analgesia was performed with sufentanil 2 μg/kg after operation in both groups.Sufentanil 5 μg was intravenously injected as rescue analgesic,and the visual analog scale score was mainrained ≤3 within 48 h after operation.The intraoperative consumption of remifentanil and extubation time after operation were recorded.The requirement for sufentanil as rescue analgesic and development of nausea and vomiting,itching and respiratory depression were recorded within 48 h after surgery.Results Compared with group GA,the intraoperative consumption of remifentanil and requirement for sufentanil as rescue analgesic within 48 h after surgery were significantly reduced,the time of extubation was shortened,and the incidence of nausea and vomiting,itching and respiratory depression was decreased in group TAPB-GA (P＜ 0.05).Conclusion Ultrasound-guided TAPB can provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation under general anesthesia.