“S-Nerve型”超声引导下行腹横肌平面阻滞的临床研究

目的:探讨“S-Nerve型”超声引导下腹横肌平面阻滞（TAPB）在老年患者中的临床应用。方法:选取40例腹腔镜结 直肠癌根治术的老年患者，随机分为观察组和对照组，各20例。对照组进行全凭静脉麻醉，观察组全麻诱导后在“S-Nerve 型”超声引导下双侧TAPB，每侧给予0.5 μg/kg右美托咪定2 mL复合0.2%罗哌卡因1 mg/kg的混合液。比较两组患者术 前（T0）、切皮（T1）、手术30 min（T2）、气管拔管即刻（T3）的平均动脉压（MAP）、心率（HR）、皮质醇（Cor），术中麻醉药用量， 术后2、6、12、24 h的疼痛视觉模拟评分（VAS），术前1 d、术后1 d、术后3 d的简易精神状态量表（MMSE）评分及术后认知 功能障碍发生率。结果:观察组超声引导下一次穿刺成功率为100%。T1、T2、T3时点，观察组MAP、HR、Cor均显著低于对 照组（P<0.05）。观察组术中丙泊酚和瑞芬太尼用量均显著低于对照组（P<0.05）。术后2、6、12 h，观察组VAS评分均显著 低于对照组（P<0.05）。术后1 d，观察组MMSE评分显著高于对照组（P<0.05），认知功能障碍发生率为15%，显著低于对 照组的45%（P<0.05）。结论:对于老年腹腔镜手术患者，实施“S-Nerve型”超声引导下TAPB，具有可视化、定位准确的优 势，减少盲穿的损伤风险，而且相比单纯全麻，全麻中联合应用超声引导下TAPB，有利于降低手术应激反应，减少术中麻 醉药用量，减轻术后疼痛，改善术后认知功能。 【关键词】S-Nerve型；超声引导；腹横肌平面阻

Clinical study on transversus abdominis plane block by "S-Nerve" ultrasound guidance

Abstract: Objective To observe the clinical effects of transversus abdominis plane block (TAPB) by "S-Nerve" ultrasound guidance on elderly patients. Methods Forty elderly patients undergoing laparoscopic radical resection of colorectal cancer were enrolled and randomly divided into observation group and control group, with 20 cases in each group. The patients in control group were given total intravenous anesthesia, while those in observation group were given "S-Nerve" ultrasound-guided bilateral TAPB after general anesthesia induction, with the mixture of 2 mL of 0.5 μg/kg dexmedetomidine and 0.2%of 1 mg/kg ropivacaine each lateral. The mean arterial pressure (MAP), heart rate (HR) and cortisol level (Cor) before operation (T0), at skin incision (T1), at 30 min of operation (T2) and immediately tracheal extubation (T3) were compared between two groups. Moreover, intraoperative anesthetic dosages, the pain visual analogue scale (VAS) scores at 2, 6, 12 and 24 h after operation, the mini-mental state examination (MMSE) scores at 1 d before operation, at 1 d after operation and at 3 d after operation and the incidence rate of postoperative cognitive dysfunctions were also compared. Results The success rate of ultrasound-guided one-time puncture was 100% in observation group.At T1, T2 and T3, the MAP, HR and Cor in observation group were significantly lower than those in control group (P<0.05). The dosages of intraoperative propofol and remifentanil in observation group were significantly less than those in control group (P<0.05).At 2, 6 and 12 h after operation, the VAS scores in observation group were significantly lower than those in control group (P<0.05).At 1 d after operation, the MMSE score in observation group was significantly higher than that in control group (P<0.05), and the incidence rate of cognitive dysfunctions in observation group was 15%, significantly lower than 45% in control group (P<0.05). Conclusion For elderly patients undergoing laparoscopic surgery, TAPB guided by "S-Nerve" ultrasound has the advantages of visualization and accurate positioning, and reduces the risk of blind puncture injuries. Compared with general anesthesia, general anesthesia combined with ultrasound-guided TAPB is more effective in relieving surgical stress responses, lowering intraoperative anesthetic dosages, reducing postoperative pain and improving postoperative cognitive function.