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| 超声引导下不同浓度罗哌卡因肋缘下入路腹横肌平面阻滞在上腹部手术中的效果 |
| Research on combination of general anesthesia and ultrasound-guided oblique subcostal transversus abdominis plane block with different concentration of ropivacaine for upper abdominal surgery |
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| DOI：10.12089/jca.2018.02.011 |
| 中文关键词: 罗哌卡因 超声引导腹横肌平面阻滞 复合麻醉 |
| 英文关键词: Ropivacaine Ultrasound-guided transversus abdominis plane block Combined anesthesia |
| 基金项目: |
| 作者 | 单位 | E-mail | | 代元强 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | | | 文平山 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | | | 陈君 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | | | 戴柠宇 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | | | 马宇 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | | | 许涛 | 200433,上海市,第二军医大学附属长海医院麻醉学部临床麻醉科 | taoxu_smmu@163.com |
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| 中文摘要: |
| 目的 探讨超声引导下不同浓度罗哌卡因肋缘下入路腹横肌平面(oblique subcostal transversus abdominis plane, OSTAP)阻滞在上腹部手术中的效果。方法 选择上腹部手术患者147例, 男85例, 女62例,年龄18～80岁，ASA Ⅰ或Ⅱ级, 随机分成四组。四组术前双侧肋缘下入路，A组（n=41）、B组（n=55）、C组（n=37）分别给予0.375%、0.5%、0.75%罗哌卡因共2.5 mg/kg, D组（n=14）双侧各给予生理盐水20 ml。术中静-吸复合麻醉, 七氟醚0.8～1.0 MAC维持, 右美托咪定0.5 μg/kg, 并瑞芬太尼0.1 μg·kg-1·min-1持续微泵。术后使用酒石酸布托啡诺与氟比洛芬酯静脉镇痛48 h。观察患者舒芬太尼、瑞芬太尼用量、血管活性药物用量、出血量。并记录患者术后12、24 h VAS评分、术后12 h芬太尼用量、术后肠道排气时间和住院时间。结果 A、B、C组舒芬太尼用量分别为(30.5±9.4)、(27.4±7.4)和(30.9±8.8)μg, 均明显少于D组的(47.1±9.3)μg(P<0.05)。四组术中瑞芬太尼、血管活性药物用量、术中出血量、术后12、24 h VAS评分、术后12 h芬太尼用量、排气时间、住院时间差异无统计学意义。结论 静-吸复合麻醉下，超声引导下罗哌卡因OSTAP阻滞可以明显减少术中阿片类药物的应用。不同浓度罗哌卡因阻滞效果无明显差异。 |
| 英文摘要: |
| Objective To investigate the effect of ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery. Methods One hundred forty-seven patients underwent upper abdominal surgery, 85 males and 62 females, aged 18-80 years, ASA physical status Ⅰ or Ⅱ, were recruited and randomly divided into four groups. Bilateral ultrasound-guided OSTAP block were performed in each group. Ropivacaine hydrochloride injection of 2.5 mg/kg were performed in each of group A (n=41), B (n=55), C (n=37) while concentration was 0.375%, 0.5%, 0.75%, respectively. Group D (n=14) was received 20 ml of saline solution for each side. Intravenous-inhalation combined anesthesia was conducted during the surgery, with sevoflurane 0.8-1.0 MAC, dexmedetomidine 0.5 μg/kg iv, remifentanil 0.1 μg·kg-1·min-1 iv. Each group was received patient-controlled intravenous analgesia (PCIA) after surgery which contained butorphanol tartrate and flurbiprofen axetil. The consumption of opioids and vasoactive drugs, hemodynamic parameters in operation were recorded. The visual analogue scale (VAS) scores were evaluated at 12 and 24 h after operation, the location and degree of abdominal pain, fentanyl used for acute pain during the first 12 h after operation, the postoperative intestinal exhaust time and hospitalization time were also recorded. Results There was no difference in basic states, duration of operation or blood loss in each group. The consumption of sufentanil in operation in groups A, B and C was (30.5±9.4) μg, (27.4±7.4) μg, (30.9±8.8) μg, respectively, which were significantly lower than that in group D ［(47.1±9.3) μg］ (P＜0.05). There was no difference in vasoactive drugs between the four groups. There was no difference in hemodynamic indexes in the TAP block groups. There was no significant difference in intraoperative blood loss between the four groups the VAS scores. There was no difference in the location and degree of abdominal pain, fentanyl used for acute pain, the postoperative intestinal exhaust time and hospitalization time. Conclusion Intraoperative opioids consumption in combined general anesthesia was reduced by ultrasound-guided OSTAP block. There is no difference between the effect of OSTAP block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery. |
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