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| 腹横肌平面阻滞在肠梗阻合并感染性休克患者中的应用 |
| Application of transverse abdominis plane block in patients with intestinal obstruction and septic shock |
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| DOI：10.12089/jca.2020.11.002 |
| 中文关键词: 肠梗阻 感染性休克 胃肠功能 腹横肌平面阻滞 超声 |
| 英文关键词: Intestinal obstruction Septic shock Gastrointestinal function Transversus abdominis plane block Ultrasound |
| 基金项目:北京市科委首都特色研究项目（Z151100003915101） |
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| 中文摘要: |
目的 探讨腹横肌平面阻滞（TAP）对肠梗阻合并感染性休克腹部手术患者围术期血流动力学及术后胃肠功能的影响。
方法 选择诊断肠梗阻合并感染性休克拟行剖腹探查术患者64例，男32例，女32例，年龄36~62岁，BMI 18~40 kg/m2，ASA Ⅱ或Ⅲ级。将患者随机分为两组：全身麻醉联合TAP组（GB组），单纯全身麻醉组（G组），每组32例。两组全身麻醉方案一致，GB组全麻诱导后行双侧TAP，G组只接受标准全身麻醉。两组患者术后应用持续静脉自控镇痛。记录入室后（T0）、全身麻醉诱导后（T1）、切皮时（T2）、切皮后1 h（T3）、缝皮时（T4）、拔管时（T5）的HR、MAP；记录T1—T4时心输出量（CO）、每搏变异度（SVV）；记录T0、T3、T5、术后12 h（T6）剩余碱（BE）、乳酸（Lac）变化；手术全程舒芬太尼用量、去甲肾上腺素用量、苏醒时间、拔管时间和术后24 h内按压次数；记录拔管后、术后2、6、12、24 h VAS评分，术后肠鸣音恢复时间、排气时间、进食时间、排便时间、术后住院时间；记录吻合口瘘、切口感染等不良反应发生率。
结果 与G组比较，GB组T2—T5时HR明显减慢（P＜0.05），MAP明显升高（P＜0.05），T3、T4时CO明显升高（P＜0.05），T3、T5、T6时BE明显升高（P＜0.05），Lac明显降低（P＜0.05），术中舒芬太尼用量、去甲肾上腺素用量、拔管后即刻、术后2、6、12 h VAS评分和术后24 h内按压次数均明显降低（P＜0.05），苏醒时间、拔管时间、术后肠鸣音恢复时间、排气时间、进食时间、排便时间、术后住院时间明显缩短（P＜0.05）。两组吻合口瘘、切口感染等并发症差异无统计学意义。
结论 全身麻醉联合TAP用于肠梗阻合并感染性休克腹部手术患者，可维持术中血流动力学稳定并降低无氧酵解；术后加快胃肠道功能恢复，是更为理想的麻醉方案。 |
| 英文摘要: |
Ojective To investigate the effect of transverse abdominal plane block (TAP) on perioperative hemodynamics and postoperative gastrointestinal function in patients with intestinal obstruction and septic shock.
Methods Sixty-four patients with intestinal obstruction combined septic shock were selected for exploratory laparotomy, including 32 males and 32 females, aged 36-62 years, BMI 18-40 kg/m2, falling into ASA physical status Ⅱ-Ⅲ. Patients were randomly divided into general anesthesia combined TAP group (group GB) and general anesthesia group (group G), with 32 patients in each group. General anesthesia protocols of two groups were the same. Group GB received bilateral TAP after general anesthesia induction, while group G only received standard general anesthesia. Patients in both groups were treated by patient-controlled analgesia. HR and MAP were recorded in the two groups after entry operation room (T0), at the time of induction of general anesthesia (T1), at the time of incision (T2), 1 h after incision (T3), at the time of suture (T4) and at the time of extubation (T5). The cardiac output (CO) and stroke volume variation (SVV) of T1-T4 were recorded. The changes of base excess (BE) and lactic acid (Lac) at T0, T3, T5 and 12 h after operation (T6) were recorded. At the end of the operation, the dosage of sufentanil and norepinephrine, recovery time, extubation time and the compressions within 24 h were recorded. The VAS score after extubation, 2, 6, 12, 24 h after surgery were recorded. Postoperative bowel sounds recovery time, exhaust time, feeding time, defecation time and postoperative hospitalization were recorded in both groups. The incidence of postoperative anastomotic fistula and incision infection were recorded as well.
Results Compared with group G, in group GB, HR slowed down during T2-T5 (P < 0.05), MAP increased significantly during T2-T5 (P < 0.05), and CO was significantly increased during T3-T4 (P < 0.05), BE of group GB at T3, T5 and T6 was significantly higher (P < 0.05), and Lac was significantly lower (P < 0.05). Compared with group G, intraoperative sufentanil dosage, noradrenaline dosage, recovery time, extubation time, VAS scores after extubation, at 2, 6, 12 h postoperatively and the number of compressions within 24 h after operation in group GB were significantly lower (P < 0.05). The recovery time of bowel sounds, exhaust time, feeding time, defecation time and postoperative hospitalization in group GB were significantly shorter than group G (P < 0.05).
Conclusion General anesthesia combined with TAP anesthesia is an ideal option for patients with intestinal obstruction and septic shock during abdominal surgery, which can maintain the hemodynamic stability, reduce the anaerobic digestion, and accelerate the recovery of gastrointestinal function after operation. |
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