ERAS理念下应用TAPB联合RSB在LC手术中的效果

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)应用加速康复外科(enhanced recovery after surgery, ERAS)理念下不同模式神经阻滞后患者康复质量及安全性分析。方法 选取于我院行LC手术患者85例，均给予LC治疗，根据术后神经阻滞模式将患者分为T组(22例)、TR组(20例)、P组(21例)和N组(22例),T组给予右侧肋缘腹横肌平面阻滞(transversus abdominis plane block, TAPB),TR组给予TAPB联合右侧腹直肌鞘阻滞(rectus sheath block, RSB),P组给予静脉自控镇痛，N组不给予镇痛干预，观察各组手术时间、术中出血量、Ramsay镇静评分、视觉模拟评分法(visual analogue scale, VAS)疼痛评分等差异。结果 T组、TR组、P组和N组手术时间、术中出血量和术后住院时间比较差异无统计学意义(P>0.05)。TR组术后首次排气时间、术后下床活动时间明显低于T组(P<0.05),而与P组比较差异无统计学意义(P>0...

Effect of TAPB combined with RSB in LC surgery under the concept of ERSA

ObjectiveTo investigate the rehabilitation quality and safety of patients after different modes of nerve block under the concept of enhanced recovery (ERAS) in laparoscopic cholecystectomy (LC).MethodsA total of 85 patients who underwent LC in our hospital were selected and treated with LC. According to the postoperative nerve block mode, the patients were divided into T group (n=22), TR group (n=20), P group (n=21) and N group (n=22). T Group was given right lateral costal transverse abdominal muscle plane block (TAPB), TR group was given TAPB combined with right rectus abdominis sheath block (RSB), A group was given patient-controlled intravenous analgesia (PCIA), and N group was not given analgesic intervention. The differences in duration of operation, intraoperative bleeding, Ramsay sedation score (RSS) and visual analogue scale (VAS) score in each group were observed.ResultsThere was no significant difference in T group, TR group, P group and N group with respect to duration of operation, intraoperative bleeding and length of postoperative hospital stay (P＞0.05). The time of first exhaust and the first time of off-bed activity after operation in TR group were significantly lower than those in T group (P＜0.05), but there was no significant difference compared with P group (P＞0.05). There was no significant difference in RSS among the four groups in terms of interaction between groups, time points, time points between groups (P＞0.05). The VAS pain scores of the four groups were statistically significant in terms of interaction between groups, time points, and time points between groups. With the extension of time, the VAS pain scores of the four groups showed a downward trend (P＜0.05). At 24 h after operation, C reactive protein（CRP）, interleukin 6（IL-6）, cortisol（Cor） and E in the four groups were significantly better than those after operation, suggesting significant differences (P＜0.05). At 24 h after operation, CRP, IL-6, Cor and E in T group, TR group and P group were lower than those in N group, and CRP, IL-6, Cor and E in TR group were lower than those in T group at 24 h after operation, with no significant difference (P＜0.05). There was no significant difference between TR group and P group (P＞0.05). At 24 h after operation, CO and SV in the four groups were better than those after operation, and the difference was statistically significant (P＜0.05). At 24 h after operation, CO in T group, TR group and P group was higher than that in N group, while SV was lower than that in N group; CO in TR group was higher than that in T group, while SV was lower than that in T group, and the difference was statistically significant (P＜0.05); there was no significant difference between TR group and P group (P＞0.05). There was no significant difference in the interaction between groups, time points, and time points between groups with respect to the scores of the Mini-mental State Examination (MMSE) in the four groups (P＞0.05), but there was significant difference between time points. The MMSE score increased with time after surgery (P＜0.05). There was no significant difference among the four groups (P＞0.05).ConclusionUnder the concept of ERAS, the application of TAPB combined with RSB in LC surgery can effectively reduce postoperative pain and inflammatory stress response, with good safety, which is equivalent to the effect of postoperative PCIA.