超声引导下腹横平面阻滞与切口局部浸润对腹腔镜膀胱癌根治术患者快速恢复的影响

基础医学与临床 ›› 2019, Vol. 39 ›› Issue (6): 826-831.

超声引导下腹横平面阻滞与切口局部浸润对腹腔镜膀胱癌根治术患者快速恢复的影响

王晶,吴安石,艾攀,高建东,瓦斯里江?瓦哈甫

首都医科大学附属北京朝阳医院

收稿日期:2019-04-01 修回日期:2019-04-17 出版日期:2019-06-05 发布日期:2019-06-04
通讯作者: 吴安石 E-mail:wuanshi_cn@163.com
基金资助:
北京市医院管理局“青苗”计划专项经费资助

Ultrasound-guided transversus abdominis plane blocks versus local anesthetic wound infiltration in laparoscopic radical cystectomy and ERAS program

Received:2019-04-01 Revised:2019-04-17 Online:2019-06-05 Published:2019-06-04

摘要/Abstract

摘要： 目的在加速康复外科（ERAS）的背景下，探讨超声引导下腹横肌平面（US-TAP）阻滞与局部伤口浸润（LA）对腹腔镜膀胱癌根治术患者快速恢复的影响。方法将择期行腹腔镜膀胱癌根治术的70例患者随机分为: 对照组（C组，n=35）：局部伤口浸润联合静脉镇痛;研究组（S组，n=35）：超声引导下TAP阻滞联合静脉镇痛，该组患者在超声引导下行双侧TAP阻滞，每侧注射0.35%罗哌卡因20 mL（共40 mL）。所有患者围术期均采用加速康复外科（ERAS）方案，术毕两组患者均使用舒芬太尼静脉自控镇痛泵。观察并记录两组患者不同时间点静息及运动的视觉模拟疼痛（VAS）评分及术后快速康复指标；同时记录两组患者24 h阿片类药物消耗量、术后首次（PCIA）按压时间、24 h内PCA有效按压次数、患者镇痛满意度评分及不良反应（恶心、呕吐、切口感染和皮肤瘙痒）的发生情况。结果 S组患者术后24和48 h的静息和运动VAS疼痛评分较对照组显著降低(P <0.05)，首次肠道排气时间、首次下地时间及出院时间明显缩短(P<0.01)；S组术后首次PCIA按压时间明显迟于C组，PCIA有效按压次数明显少于C组，24 h舒芬太尼消耗总量、恶心呕吐的发生率明显低于C组(P <0.05)，两组在切口感染和皮肤瘙痒方面意义无统计学差异。结论与局部伤口浸润联合静脉镇痛相比，超声引导下TAP阻滞联合静脉镇痛更有利于腹腔镜膀胱癌根治患者术后早期活动，促进快速康复，并可缩短住院时间。

关键词: 术后快速康复, 区域阻滞, 腹横肌平面阻滞, 膀胱癌根治

Abstract: Objective To evaluate ultrasound guided transversus abdominis plane（U-TAP） block compared to local anesthetic（LA）wound infiltration in laparoscopic radical cystectomy and (enhanced recovery after surgery,ERAS) program.. Methods Seventy-five patients who underwent elective laparoscopic radical cystectomy were randomly divided into: control group (group C，n=35): LA combined intravenous analgesia ；study group (group S，n=35): US-TAP combined intravenous analgesia, patients received 20 ml of 0.35% ropivacaine（total 40 mL）as US-TAP inhibitors each side after the end of surgery by the anesthesiologist.All patients underwent the ERAS perioperative program and received patient-controlled intravenous analgesia (PCIA) . Visual analogue pain (VAS) score at different time points and postoperative rapid recovery index were observed and recorded in the two groups.Meanwhile, the cumulative sufentanil consumption at 24 hours, the first PCA compression time ,the number of effective compressions and patient satisfaction score,; The incidence of side effects (nausea and vomiting and pruritis) were recorded in both groups.Results Compared with group C,group S had significantly lower VAS pain score at 24h and 48h after surgery (P< 0.05), and significantly shorter time of first intestinal exhaust, first time out of bed and length of stay .(P<0.01).The first postoperative PCIA compression time, the PCIA effective compression times and the total consumption of sufentanil in 24 hours in S group were significantly less than those in C group, the incidence of nausea and vomiting in 24 hours were significantly lower in group S than that in the C group (P <0.05). There was no statistical difference between the two groups in incision infection and skin itching. Conclusions Compared with LA combined with intravenous analgesia，US-TAP block combined with intravenous analgesia is beneficial to early recovery and shortens hospital stay in laparoscopic radical cystectomy and ERAS program.

Key words: ERAS, Regional anesthesia, TAP block, radical cystectomy

中图分类号:

R614

王晶吴安石艾攀高建东瓦斯里江?瓦哈甫. 超声引导下腹横平面阻滞与切口局部浸润对腹腔镜膀胱癌根治术患者快速恢复的影响[J]. 基础医学与临床, 2019, 39(6): 826-831.

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