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| 超声引导下连续腹横肌平面阻滞对开腹直肠癌根治术患者术后早期恢复质量的影响 |
| Efficacy of ultrasound-guided continuous transverses abdominis plane block on early recovery quality in patients undergoing radical resection of rectal cancer |
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| DOI：10.12089/jca.2019.08.013 |
| 中文关键词: 超声 腹横肌平面阻滞 直肠癌根治术 恢复 |
| 英文关键词: Ultrasound Transverse abdominis plane block Radical resection of rectal cancer Rehabilitation |
| 基金项目:国家自然科学基金（81801175）；中央高校基本科研业务费专项资金资助( WK9110000044) |
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| 中文摘要: |
目的 评价超声引导下连续腹横肌平面阻滞对开腹直肠癌根治术患者术后镇痛及早期恢复质量的影响。
方法 择期全麻下行开腹直肠癌根治术患者60例，男33例，女27例，年龄45～65岁，ASA Ⅰ或Ⅱ级。随机分为两组：连续腹横肌平面阻滞组（T组）和患者自控静脉镇痛组（C组），每组30例。T组麻醉诱导后行超声引导下双侧腹横肌平面阻滞，分别注入0.25％罗哌卡因20 ml，术毕双侧分别输注0.25％罗哌卡因5 ml/h。C组术毕采用舒芬太尼1 μg/ml行PCIA。记录首次下床时间、术后首次排气时间、住院时间和补救镇痛情况；记录术后不良反应的发生情况；分别于术前1 d、术后3 d采用40项恢复质量评分量表（QoR-40量表）评估患者恢复质量。
结果 与C组比较，T组首次下床时间、肠道功能恢复时间明显缩短（P＜0.05）；补救镇痛率和恶心呕吐发生率明显降低（P＜0.05）。T组未见腹横肌平面阻滞相关并发症的发生。术后3 d T组的情绪状态评分、身体舒适度评分、心理支持评分、疼痛评分及总评分明显高于C组（P＜0.05）。
结论 超声引导下连续腹横肌平面阻滞用于开腹直肠癌根治术患者术后镇痛效果满意，提高患者术后早期恢复质量。 |
| 英文摘要: |
Objective To evaluate the effect of ultrasound-guided continuous transverses abdominis plane (TAP) block on postoperative analgesia and early recovery quality in the patients undergoing radical resection of rectal cancer.
Methods Sixty patients, 33 males and 27 females, aged 45-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for radical resection of rectal cancer under general anesthesia, were equally and randomly divided into either continuous TAP block group (group T) or patient-controlled intravenous analgesia group (group C). In group T, bilateral TAP block under ultrasound guidance was performed with 0.25% ropivacaine 20 ml after induction of anesthesia, and 0.25% ropivacaine 5 ml/h was infused on both sides after surgery. In group C, sufentanil 1 μg/ml was used for PCIA after surgery. The time of getting out of bed for the first time, recovery time of postoperative intestinal function, length of hospital stay and requirement for rescue analgesia were recorded. Postoperative adverse reactions and complications associated with TAP were also recorded. On preoperative day 1 and 3 days after surgery, the QoR-40 score scales were used to assess the recovery quality of patients.
Results Compared with group C, the emotional state score, the physical comfort score, the psychological support score, the pain score and the global QoR-40 scores were higher on 3 days after surgery in group T (P < 0.05). Compared with group C, the time of getting out of bed for the first time and recovery time of postoperative intestinal function in group T were significantly shortened than those in group C (P < 0.05). The requirement for rescue analgesia and incidence of nausea and vomiting in group T were significantly reduced than those in group C (P < 0.05).
Conclusion Ultrasound-guided continuous TAP block can provide satisfactory analgesic efficacy, and improve the early recovery quality when used for the patients undergoing radical resection of rectal cancer. |
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