目的: 探究超声引导下腹横肌平面阻滞（transversal abdominis plane block,TAPB）联合腹直肌鞘阻滞（rectus sheath block,RSB）在妇科腹腔镜手术中的应用。方法: 纳入2021年3月―2023年3月于安徽医科大学附属安庆第一人民医院接受治疗的80例妇科腹腔镜手术患者,随机分为单一组和联合组,各40例。单一组给予全凭静脉麻醉,联合组给予全凭静脉麻醉+TAPB联合RSB麻醉。比较两组患者手术指标,记录麻醉前（T0）、切皮即刻（T1）、手术结束时（T2）血流动力学[心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）],T0和术后12 h应激反应[C反应蛋白（CRP）、白介素6（IL-6）、肿瘤坏死因子-α（TNF-α）],比较两组患者术后4、8、12 h镇痛效果[疼痛视觉模拟评分（VAS）]。结果: 联合组自主呼吸时间、首次下床时间、首次排气时间均短于单一组;T0―T2时两组患者HR先升高后降低,T1时,联合组低于单一组;MAP先降低后升高,T1时,联合组高于单一组;术后12 h两组患者CRP、IL-6、TNF-α水平均较T0时升高,但联合组低于单一组;术后4、8、12 h联合组VAS评分均低于单一组。结论: TAPB联合RSB在妇科腹腔镜手术中镇痛效果良好,可稳定血流动力学,减轻应激反应及术后疼痛。
Abstract
Objective To explore the application of ultrasound-guided transversal abdominis plane block (TAPB) combined with rectus sheath block (RSB) during gynecological laparoscopic surgery. Methods 80 patients with gynecological laparoscopic surgery who received treatment in Anqing First People’s Hospital of Anhui Medical University from March 2021 to March 2023 were included and randomly divided into single group and combined group with 40 cases in each group. The single group received total intravenous anesthesia, and the combined group was given total intravenous anesthesia + TAPB combined with RSB anesthesia. Surgical indicators were compared between the two groups, and the hemodynamics [heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2) ] before anesthesia (T0), immediately after skin resection (T1) and at the end of surgery (T2). stress response indicators [C-reactive protein (CRP), interleukin-6(IL-6), tumor necrosis factor-α (TNF-α) ] at T0 and at 12 hours after surgery and analgesic effect [Visual Analogue Scale (VAS) ] at 4, 8 and 12 hours after surgery were compared between the two groups of patients. Results The spontaneous breathing time, first ambulation time and first exhaust time in combined group were shorter than those in single group. HR at T0-T2 in both groups was increased first and then decreased, and HR at T1 in combined group was lower than that in single group, and MAP was decreased first and then increased, and MAP in combined group at T1 was higher than that in single group. The levels of CRP, IL-6 and TNF-α in the two groups at 12 hours after surgery were enhanced compared with those at T0, but the levels in combined group were lower than those in single group. VAS score in combined group was lower than that in single group at 4, 8 and 12 hours after surgery. Conclusion TAPB combined with RSB has a good analgesic effect during gynecological laparoscopic surgery, and can stabilize the hemodynamics and relieve the stress response and postoperative pain.
关键词
妇科腹腔镜手术 /
腹横肌平面阻滞 /
腹直肌鞘阻滞 /
超声 /
血流动力学 /
镇痛效果
Key words
gynecological laparoscopic surgery /
transversal abdominis plane block /
rectus sheath block /
ultrasound /
hemodynamics /
analgesic effect
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基金
安徽省卫生健康委科研项目“SIRT1/AMPK/AKT通路介导七氟醚后处理改善失血性休克复苏后空间学习与记忆障碍的机制研究”（AHWJ2021a017）
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