摘要目的观察超声引导下腹横肌平面(TAP)阻滞对妇科腹腔镜手术麻醉效果及术后镇痛的影响.方法选择2015年1月至2017年7月在上海市嘉定区南翔医院择期全身麻醉下行妇科腹腔镜手术患者60例,年龄46~68岁,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级.采用随机数字表法,将其分为两组(n=30):对照组(A组)和超声引导下腹横肌平面阻滞组(B组).B组于麻醉诱导前30min在超声引导下行双侧腹横肌平面阻滞.两组于手术结束前10min连接经静脉病人自检镇痛(PCIA)泵,持续镇痛48h,维持视觉模拟(VAS)评分<4分,当VAS评分≥4分时,静脉注射舒芬太尼5μg.记录两组术中麻醉药用量,苏醒及拔管时间,记录术后24h内舒芬太尼单位时间用量、镇痛补救情况和不良反应发生情况.结果与A组比较,B组术中丙泊酚用量[(210±32)mg比(324±45)mg]、舒芬太尼用量[(31±3.6)μg比(42±3.8)μg]、术后24h内舒芬太尼单位时间用量[(3.2±0.5)μg比(5.4±0.7)μg]明显减少(P<0.001);苏醒时间[(12±3)min比(20±5)min]及拔管时间[(15±4)min比(25±7)min]明显提前(P<0.001).术后24h内镇痛补救率(13%比40%)和恶心(10%比33%)、呕吐(0%比10%)发生率降低(P<0.05).结论超声引导下腹横肌平面阻滞,可明显减少妇科腹腔镜下全子宫切除手术患者术中麻醉药用量,改善术后早期镇痛效果.

abstractsObjective To investigate the efficacy of ultrasound-guided transveses abdominis plane block (TAP) on anesthesia and postoperative analgesia in patients undergoing gynecological laparoscopic surgery.Methods From January 2015 to July 2017,60 patients aged 46 -68 yeas,of American Society of Anesthesiologists (ASA) physical status I-II,scheduled for elective gynecological laparoscopic surgery in Nanxiang Hospital of Jiading District of Shanghai were randomly divided into control group(A group) and ultrasound-guided TAP group( B group),with 30 cases in each group,In B group,ultrasound-guided TAP was performed 30 min before induction of anesthesia.The patients in both two groups received patient-controlled intravenous analgesia ( PCIA) for 48 h started from 10 min before the end of surgery.The VAS score ≥4points,sufentanil 5μg was injected intravenously.The consumption of anesthesia drugs during operation,time of consciousness and extubation,the consumption of sufentanil per hour in 24h after operation,requirement for rescue medication,and the adverse reactions within 24h after surgery were also recor-ded.Results Compared with those in A group,the consumption of propofol[(210 ± 32) mg vs.(324 ± 45) mg], sufentanil[(31 ± 3.6) μg vs.(42 ± 3.8) μg] in operation and consumption of sufentanil per hour in 24h after operation [(3.2 ± 0.5)μg vs.(5.4 ± 0.7) μg?in B group were significantly lower (P<0.001).The time of consciousness [(12 ± 3)min vs.(20 ± 5)min]and extubation[(15 ± 4)min vs.(25 ± 7)min]were significantly reduced in B group (P<0.001).The requirement for rescue medication (13% vs.40%) and the incidence rate of nausea (10% vs. 33%) and vomiting(0% vs.10%) within 24h after surgery were significantly decreased in B group compared with those in A group (P<0.05).Conclusion Ultrasound-guided TAP performed in patients undergoing gynecological laparoscopic surgery can reduce the consumption of anesthesia drugs in operation and optimize postoperative analgesia.