腹横肌平面阻滞对老年患者胃癌根治术后全麻苏醒期躁动的影响

目的 探讨腹横肌平面(TAP)阻滞对老年患者胃癌根治术后全麻苏醒期躁动的影响. 方法 选择择期经腹胃癌根治术老年患者60例,随机分为2组:即腹横肌平面阻滞组(TAP组)和对照组(N组).所有患者均于麻醉诱导插管后行超声引导下双侧肋缘下TAP阻滞,TAP组给予0.5％盐酸罗哌卡因单侧20 mL,双侧共40 mL;N组给予等量生理盐水.于麻醉诱导前(T0)、拔除气管导管时(T1)、出麻醉后恢复室时(T2)、术后8 h(T3)、术后24 h(T4)和术后48 h(T5),记录平均动脉压(MAP)、心率(HR)、Prince-Henry疼痛(PH)评分、Riker镇静躁动评分(SAS)、术后第1次下床时间和术后住院时间. 结果 TAP组疼痛评分、躁动发生率显著低于N组(P<0.05);与N组比较,TAP组T2～5时MAP和HR显著降低(P<0.05),术后第1次下床时间显著缩短(P<0.05);2组患者的术后住院时间比较,差别无统计学意义(P>0.05). 结论 TAP阻滞可减少老年患者经腹胃癌根治术后全麻苏醒期躁动的发生率,使血流动力学更稳定,有利于术后早期下床活动.

Effects of Transversus Abdominis Plane Block on Emergence Agitation in Elderly Patients Who Undergo Radical Gastrectomy Following General Anesthesia

Objective To investigate the effects of transversus abdominis plane (TAP) block on the emergence agitation from general anesthesia in elderly patients undergoing radical gastrectomy.Methods Sixty elderly patients undergoing radical gastrectomy were randomly divided into 2 groups,group TAP and group N.After induction of general anesthesia,all patients received ultrasound-guided subcostal bilateral TAP and were injected with 40 mL of 0.5％ ropivacaine (group TAP) or equivalent amount of normal saline (group N).The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before anesthesia (T0),extubation (T1),discharge from post-anesthesia care unit (T2),8 h (T3),24 h (T4) and 48 h (T5) after surgery.The Prince-Henry pain scores,Riker Sedation-agitation Scoring (SAS) were recorded at the time points of T2,T3,T4 and T5.The incidence of emergence agitation (EA),length of stay and the first out of bed time were observed.Results Compared with group N,PH scores,and incidence of EA in TAP group were significantly decreased (P<0.05),and the first out of bed time in TAP group was significantly shorten (P<0.05).The MAP and HR during T2 to T5 were significantly lower in group TAP (P<0.05).There was no significantly difference in the length of stay between the groups (P>0.05).Conclusion TAP block using 0.5％ ropivacaine significantly decreases the incidence of EA,and shortens the first out of bed time while maintains the stable hemodynamics in elder patients undergoing radical gastrectomy.