连续与单次腹横肌平面阻滞用于腹腔镜胆囊切除术后镇痛的效果比较

目的比较连续腹横肌平面阻滞(CTAPB)与单次腹横肌平面阻滞(STAPB)用于腹腔镜下胆囊切除术(LC)的术后镇痛效果。方法纳入拟行LC患者90例,分成对照组、S组和C组,每组30例,S组和C组患者气管插管后分别行STAPB和CTAPB,术毕三组患者均行患者自控静脉镇痛(PCIA),记录三组患者术后1,6,12,24,48,72 h切口部位及腹部深处疼痛视觉模拟(VAS)评分,术后72 h内PCIA镇痛泵按压次数,术后麻醉不良反应发生情况和术后镇痛的满意度。结果 S组和C组患者术后1、6和12 h切口部位和腹部深处VAS评分均显著低于对照组患者(P0.05),S组和对照组患者术后24、48和72 h切口部位和腹部深处VAS评分差异无统计学意义(P0.05),C组患者术后24、48和72 h切口部位和腹部深处VAS评分显著低于S组和对照组患者(P0.05)。术后72 h内S组和C组患者PCIA按压次数均显著少于对照组患者(P0.05),C组患者术后PCIA镇痛泵按压次数显著少于S组患者(P0.05)。S组和C组患者术后恶心发生率均低于对照组患者(P0.05)。术后S组和C组患者满意度均高于对照组患者(P0.05),C组患者满意度高于S组患者(P0.05)。结论超声引导下CTAPB可有效增强LC术后患者的镇痛效果,减少患者阿片类药物使用,降低阿片类药物不良反应发生率,提高患者术后满意度,可作为LC术后较为理想的镇痛方式。

Analysis of postoperative analgesic efficacy of continuous and single- shot transversus abdominis plane block after laparoscopic cholecystectomy

Objective To analyze the postoperative analgesic efficacy of continuous transversus transversus abdominis plane block（CTAPB）and single- shot transversus transversus abdominis plane block（SCTAPB） after laparoscopic cholecystectomy. Methods Ninety patients scheduled for laparoscopic cholecystectomy were divided to three groups（n=30, each）：the control group, STAPB group（group S） and CTAPB（group C）. In group S and group C, STAPB and CTAPB were performed after the tracheal intubation respectively, and patient- controlled intravenous analgesia（PCIA）were performed in all the patients in three groups postoperatively. Visual Analog Scale（VAS）scores of the superficial incisional site and deep abdominal pain at 1, 6, 12, 24, 48, 72 h, total pressing times of PICA pumps, adverse effects and patients′ satisfaction degrees for postoperative analgesia of all the postoperative patients were recorded. Results VAS scores of the superficial incisional site and deep abdominal pain at 1, 6 and 12 h were significantly lower in group S and group C than that in the control group（P<0.05）. There was no significant difference in the VAS scores of the superficial incisional site and deep abdominal pain at 24, 48 and 72 h between group S and the control group（P>0.05）, however, it was lower in group C than that in group S and control group（P<0.05）. Total pressing times of PICA pumps in group S and group C were significantly less than that in the control group（P<0.05）, and it was less in group C than that in group S significantly（P<0.05）. Incidence rates of nausea were lower in group S and group C than that in the control group（P<0.05）. Patients′ satisfaction degrees for postoperative analgesia were higher in group C than that in group S, and it was also higher in group C than that in group S（P<0.05）. Conclusions Ultrasound-guided CTAPB could enhance postoperative analgesic efficacy, reduce opioid con-sumptions and improve patients′ satisfaction degrees for postoperative analgesia, which might become an ideal analgesic method after laparoscopic cholecystectomy.