超声引导腹横肌阻滞在腹腔镜胆囊切除术应用的临床观察

目的 探讨超声引导下腹横肌阻滞（transversus abdominis plane block,TAP block）对腹腔镜胆囊切除术患者术后镇痛的效果.方法 选择择期全麻下行腹腔镜胆囊切除手术患者40例,随机分为2组（每组20例）,A组：切皮前超声引导下以0.5%罗哌卡因行双侧腹横机阻滞,每侧20ml;B组：不做任何处理.两组麻醉诱导、维持方法 相同,均采用全凭静脉麻醉联合喉罩气道管理,术后持续监测无创血压、心电图、呼吸、脉搏血氧饱和度.记录术后2、4、8、12、24h 的VAS 评分和术后额外镇痛药使用情况及不良反应发生情况.结果 A组在术后4、8、12h 镇痛效果优于B组（ P＜0.05） ;A组额外镇痛药使用次数少于B 组（P〈0.05）;恶心,呕吐,皮肤瘙痒及呼吸抑制2组间比较,差异无统计学意义（P〉0.05）.结论 超声引导下腹横肌阻滞对腹腔镜胆囊切除术患者具有很好的镇痛效果.

The post-operation analgesic effect of transversus abdominis plane block under ultrasound-guided for patients undergoing laparoscopic cholecystectomy

Objective To investigate the postoperative analgesic effects of transversus abdominis plane block （ TAP block） under ultrasound-guided for patients undergoing laparoscopic cholecystectomy. Methods 40 patients who underwent laparoscopic cholecystectomy under general anesthesia were randomly divided into 2 groups （each group of 20 patients） , group A： Before skin incision, every patient was performed with ultrasound-guided bilateral TAP block, and with 20mL 0.5% ropivacaine hydrochloride on each side. ; Group B： Not used any local analgesic procedures. All of the patients were performed the same general anesthesia process, which made of total intravenous anesthesia combined with laryngeal mask airway management. Postoperative continuous monitoring of non-invasive blood pressure, ECG, respiration, pulse oxygen saturation were applied. V AS score of 2, 4, 8, 12 and 24 hours after operation and additional analgesia drug using and incidence of side effects were recorded. Results

At 4, 8, 12 hrs after operation, the postoperative analgesic effects in group A is better than that of group B （P 〈 0.05） ; The frequency of additional using of analgesic drugs in group A is lesser than that of group B （ P 〈 0. 05） , and there were no significant different in the incidence rate of side effects , such as nausea ,vomiting, skin pruitus and respiratory depression, between the two groups （P 〉 0. 05） 0 Conclusion By using transversus abdominis plane block （TAP block） under ultrasound-guided can make content postoperative analgesic effects for patients undergoing laparoscopic cholecystectomy.