腹横肌平面腹直肌鞘阻滞在腹腔镜胆囊手术中的应用

卢建朴 王传镇 张建辉 李艳媛

[摘要] 目的 分析腹橫肌平面腹直肌鞘阻滞在腹腔镜胆囊手术中的应用价值。 方法 选择2019年1月至2020年6月于我院行腹腔镜胆囊手术治疗患者80例，40例予以全麻（全麻组），40例予以腹横肌平面腹直肌鞘阻滞+全麻（阻滞组），比较两种麻醉方式对平均动脉压、心率、术中丙泊酚及瑞芬太尼用量、术后拔除气管导管时间、术后下床时间的影响，并对不良反应发生情况、术后咳嗽时VAS疼痛评分进行比较。 结果 两组T1时平均动脉压、心率比较，差异无统计学意义（P>0.05）;两组T2时平均动脉压、心率有所降低，差异无统计学意义（P>0.05）;两组T3时平均动脉压、心率比较，全麻组均高于阻滞组，差异有统计学意义（P<0.05）。全麻组丙泊酚用量为（451.55±90.54）mg，高于阻滞组的（402.25±111.41）mg;全麻组瑞芬太尼用量为（412.64±84.42）μg，高于阻滞组的（365.12±98.11）μg;差异有统计学意义（P<0.05）。全麻组术后拔除气管导管时间为（12.31±5.41）min，阻滞组为（12.11±5.92）min，差异无统计学意义（P>0.05）;全麻组术后下床时间为（21.51±3.74）h，长于阻滞组的（15.32±4.91）h，差异有统计学意义（P<0.05）。全麻组不良反应总发生率为37.50%，高于阻滞组的10.00%，差异有统计学意义（P<0.05）。全麻组术后2、6、12 h咳嗽时VAS评分均高于阻滞组，差异有统计学意义（P<0.05）;术后24 h咳嗽时VAS评分比较，差异无统计学意义（P>0.05）。 结论 腹腔镜胆囊手术患者应用腹横肌平面腹直肌鞘阻滞可维持术中循环平稳，为患者提供良好的镇痛效果，减少并发症，促进患者快速康复。

[关键词] 腹腔镜胆囊手术;腹横肌平面腹直肌鞘阻滞;术后下床时间;不良反应;VAS评分

[中图分类号] R657.4          [文献标识码] B          [文章编号] 1673-9701（2021）36-0120-04

The application of transversus abdominis plane and rectus sheath block in laparoscopic gallbladder surgery

LU Jianpu   WANG Chuanzhen   ZHANG Jianhui   LI Yanyuan

Department of Anesthesia， Shishi Hospital in Fujian Province， Shishi   362700， China

[Abstract] Objective To analyze the application value of transversus abdominis plane and rectus sheath block （TAPB+RSB） in laparoscopic gallbladder surgery. Methods A total of 80 patients who underwent laparoscopic cholecystectomy in our hospital from January 2019 to June 2020 were selected， with 40 patients received general anesthesia （the general anesthesia group） and another 40 patients received TAPB+RSB+general anesthesia （the block group）. The effects of the two anesthesia methods on mean arterial pressure， heart rate， intraoperative dosage of propofol and remifentanil， postoperative tracheal tube removal time， postoperative time to get out of bed were compared， and the occurrence of adverse reactions and VAS pain score during postoperative cough were compared. Results There were no statistically significant differences between the two groups in the mean arterial pressure （MAP） and heart rate （HR） at T1 （P>0.05）. The MAP and HR in both groups were reduced at T2， without statistically significant differences （P>0.05）. The MAP and HR in the general anesthesia group were higher than those in the block group at T3， with statistically significant differences （P<0.05）. The dosage of propofol in the general anesthesia group （451.55±90.54） mg was higher than （402.25±111.41） mg in the block group， and the dosage of remifentanil （412.64±84.42） μg in the general anesthesia group was higher than （365.12±98.11） μg in the block group， with statistically significant differences （P<0.05）. The time to remove the tracheal tube after surgery was （12.31±5.41） min in the general anesthesia group and （12.11±5.92） min in the block group， without statistically significant differences between the two groups （P>0.05）. The time to get out of bed after surgery in the general anesthesia group （21.51±3.74） h was longer than （15.32±4.91） h in the block group， with statistically significant differences （P<0.05）. The total incidence of adverse reactions in the general anesthesia group was 37.50%， which was higher than 10.00% in the block group， with statistically significant differences （P<0.05）. The Visual Analogue Scale （VAS） scores for cough at 2， 6 and 12 h after surgery in the general anesthesia group were higher than those in the block group， with statistically significant differences （P<0.05）， while there was no statistically significant difference between the two groups in VAS score for cough at 24 h after surgery （P>0.05）. Conclusion The application of TAPB+RSB in patients undergoing laparoscopic gallbladder surgery can maintain smooth intraoperative circulation， provide good analgesic effects for patients， as well as reduce complications and promote rapid rehabilitation of patients.

[Key words] Laparoscopic gallbladder surgery; Transversus abdominis plane and rectus sheath block; Time to get out of bed after surgery; Adverse reactions; VAS score

腹……