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| 超声引导下腹横肌平面阻滞对老年衰弱患者腹腔镜胆囊切除术后肺部并发症的影响 |
| Effect of ultrasound-guided transversus abdominis plane block on postoperative pulmonary complications in elderly frail patients undergoing laparoscopic cholecystectomy |
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| DOI：10.12089/jca.2026.01.007 |
| 中文关键词: 超声 腹横肌平面阻滞 衰弱 老年 术后肺部并发症 肺功能 |
| 英文关键词: Ultrasound Transversus abdominis plane block Frailty Aged Postoperative pulmonary complications Pulmonary function |
| 基金项目:江苏省卫生健康委医学科研重点项目（K2024021）；江苏省中医院科主任提升专项课题（Y2022ZR29） |
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| 中文摘要: |
目的：评价超声引导下腹横肌平面阻滞（TAPB）对老年衰弱患者腹腔镜胆囊切除术（LC）后肺部并发症的影响。
方法：选择择期全麻下行LC的老年衰弱患者，年龄65～80岁，ASA Ⅱ或Ⅲ级，术前表型评估法（Fried）评分≥3分。采用随机数字表法将患者分为两组：超声引导下TAPB组(T组)和对照组(C组)。手术结束后、麻醉苏醒前，T组进行双侧超声引导下TAPB，分别注入0.375%罗哌卡因20 ml；C组在相同部位分别注入生理盐水20 ml。主要指标为术后7 d内肺部并发症（PPCs）发生率。次要指标包括术前1 d、术后1 d血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、第1秒用力呼气容积（FEV1）、用力肺活量（FVC），FEV1/FVC的值，术后住院时间、补救镇痛情况、术后1、12、24 h的VAS疼痛评分以及术后24 h内镇痛泵总按压、有效按压次数和舒芬太尼总用量。
结果：共纳入患者78例，其中T组38例，C组40例。与C组比较，T组术后7 d内PPCs发生率明显降低（P＜0.05）。与术前1 d比较，两组术后1 d血清IL-6和TNF-α浓度明显升高，FEV1、FVC和FEV1/FVC明显降低。与C组比较，T组术后1 d 血清IL-6和TNF-α浓度明显降低，FEV1、FVC和FEV1/FVC明显升高，术后住院时间明显缩短，补救镇痛率明显降低，术后1、12、24 h VAS疼痛评分明显降低，术后24 h内镇痛泵总按压和有效按压次数明显减少、舒芬太尼总用量明显降低（P＜0.05）。
结论： 超声引导下TAPB可有效降低老年衰弱患者LC术后肺部并发症，改善术后肺功能，减轻术后疼痛，缩短住院时间。 |
| 英文摘要: |
Objective: To evaluate the effect of ultrasound-guided transversus abdominis plane block (TAPB) on postoperative pulmonary complications (PPCs) in elderly frail patients undergoing laparoscopic cholecystectomy (LC).
Methods: Elderly frail patients aged 65-80 years, ASA physical status Ⅱ or Ⅲ, with a preoperative Fried frailty phenotype score ≥ 3 scheduled for elective LC under general anesthesia were selected. Patients were randomly assigned to two groups: TAPB group (group T) and control group (group C). Immediately after surgery but before anesthesia recovery, group T received bilateral ultrasound-guided TAPB with 20 ml of 0.375% ropivacaine per side, while group C received 20 ml of normal saline at the same sites. The primary outcome was the incidence of PPCs within 7 days postoperatively. Secondary outcomes included serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (measured preoperatively and on postoperative day 1), length of hospital stay, rescue analgesia requirements, visual analog scale (VAS) pain scores at 1, 12, and 24 hours postoperatively, and total number of patient-controlled analgesia compressions, effective compressions, and total sufentanil consumption within 24 hours postoperatively.
Results: Seventy-eight patients were included, 38 patients in group T, 40 patients in group C. Compared with group C, group T had a significantly lower incidence of PPCs within 7 days postoperatively (P < 0.05). Compared with 1 day before surgery, the serum IL-6 and TNF-α concentrations were significantly higher, and FEV1, FVC, and FEV1/FVC were significantly lower 1 day before the surgery in both groups (P < 0.05). Compared with group C, the serum IL-6 and TNF-α concentrations were significantly lower, and FEV1, FVC and FEV1/FVC were significantly higher in group T 1 day after the surgery (P < 0.05). Compared with group C, the postoperative length of hospital stay, and salvage analgesia rate were significantly reduced, and significantly lower VAS scores 1 hour, 12 and 24 hours postoperatively, the total number of compressions, effective compressions, and total dose of sufentanil were significantly reduced in group T within 24 hours after surgery (P < 0.05).
Conclusion: Ultrasound-guided TAPB could effectively reduce the incidence of PPCs, improve postoperative pulmonary function, alleviate pain, and shorten hospital stay in elderly frail patients undergoing LC. |
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