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| 超声引导下腹横肌平面阻滞联合双氯芬酸钠栓对腹腔镜下子宫切除患者术后早期恢复的影响 |
| Effect of transversus abdominis plane block combined with diclofenac sodium suppositories on postoperative early recovery after laparoscopic hysterectomy |
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| DOI：10.12089/jca.2018.04.012 |
| 中文关键词: 腹横肌平面 双氯芬酸钠栓 术后镇痛 恢复 |
| 英文关键词: Transversus abdominis plane Diclofenac sodium suppositories Postoperative analgesia Recovery |
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| 中文摘要: |
| 目的 观察超声引导下腹横肌平面阻滞联合双氯芬酸钠栓纳肛对腹腔镜子宫切除术后镇痛效果及早期恢复的影响。方法 腹腔镜子宫切除术患者66例,年龄40～60岁，随机分为T组和D组,每组33例。T组于手术结束后在超声引导下行双侧腹横肌平面阻滞,每侧注射0.4％罗哌卡因25 ml,D组予双侧腹横肌平面阻滞加双氯芬酸钠栓纳肛。所有患者均用舒芬太尼行PCIA。记录术后24 h镇痛泵舒芬太尼用量及有效按压次数;测定术后24 h躁动和恶心呕吐发生率、首次下床活动时间、首次肛门排气时间及拔尿管时间;检测麻醉前、术后即刻及术后8、12 h血浆白细胞介素-6(IL-6)、C反应蛋白(CRP)及皮质醇(Cor)浓度。结果 术后24 h，T组舒芬太尼用量(40.8±5.1)μg,有效按压次数（20.4±3.5）次；D组舒芬太尼用量(18.6±3.2)μg，有效按压次数（9.3±2.2）次；与T组比较,D组舒芬太尼用量及有效按压次数均明显减少(P＜0.05)。D组躁动和恶心呕吐发生率均明显低于T组(P＜0.05),术后12 h的血浆IL-6、CRP、Cor浓度均明显少于T组(P＜0.05)。两组下床活动时间和肛门排气及拔尿管时间差异无统计学意义。结论 腹横肌平面阻滞联合双氯芬酸钠栓纳肛可对腹腔镜子宫切除提供安全有效的术后镇痛,利于早期快速恢复。 |
| 英文摘要: |
| Objective To observe the effect of ultrasound-guided transversus abdominis plane block combined with diclofenac sodium suppository in anus on postoperative analgesia and early recovery after laparoscopic hysterectomy. Methods Sixty-six patients of laparoscopic hysterectomy, aged 40-60 years, were randomly divided into group T and group D, 33 cases in each group. Group T used ultrasound-guided bilateral transversus abdominis plane (TAP) block after surgery. Group D used TAP block and diclofenac sodium suppositories in anus. All patients received PCIA. Postoperative 24 h sufentanil dosage out of analgesia pump and the effective press times were recorded. The incidence of dysphoria, nausea and vomit within postoperative 24 h, the time of first out-of-bed activity, the time of first anal exhaust and the time of removing urine tube were measured. The plasma concentration of interleukin-6(IL-6), C reactive protein (CRP) and cortisol (Cor) were recorded at the following four time points: before anesthesia, just postoperative moment, 8 and 12 h after surgery. Results Compared with group T, the sufentanil dosage [(18.6±3.2) μg vs (40.8±5.1) μg] and the effective press times [(9.3±2.2) times vs (20.4±3.5) times] were fewer in group D (P＜0.05). The incidence of dysphoria, and nausea and vomit were less in group D compared with group T (P＜0.05). The IL-6, CRP and Cor of group D at 12 h were lower than those of group T (P＜0.05). But the times of first out-of-bed activity, anal exhaust and removing urine tube in two groups were not significantly different. Conclusion Transversus abdominis plane block combined with diclofenac sodium suppositories in anus can provide safe and effective postoperative analgesia for laparoscopic hysterectomy, and promote the early fast recovery. |
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