【摘要】：目的探討腹橫筋膜(transversus abdominis plane,TAP)阻滯在腹腔鏡直腸癌低位前切除術(shù)后鎮(zhèn)痛中的應(yīng)用價值。方法選擇2015年3月~2016年11月北京朝陽醫(yī)院腹腔鏡直腸癌低位前切除術(shù)68例,以隨機(jī)數(shù)字表法分為2組。TAP組33例,麻醉插管后在超聲引導(dǎo)下以0.375%羅哌卡因20 ml行雙側(cè)TAP阻滯;對照組35例,按同樣方法注射等劑量生理鹽水。比較2組術(shù)后2、4、8、12、24 h靜態(tài)及動態(tài)疼痛數(shù)字評分(numeric rating scale,NRS),以及術(shù)后腸蠕動恢復(fù)(有腸鳴音)時間、術(shù)后首次下床活動時間、術(shù)后住院時間、圍手術(shù)期治療費用、術(shù)后并發(fā)癥。結(jié)果與對照組相比,TAP組術(shù)后恢復(fù)腸鳴音早[(28.1±9.8)h vs.(35.6±9.4)h,t=-3.214,P=0.002],術(shù)后首次下床早[(1.7±0.6)d vs.(2.0±0.6)d,t=-2.030,P=0.046],術(shù)后住院時間短[(7.1±1.2)d vs.(7.8±1.7)d,t=-2.122,P=0.038]。TAP組術(shù)后2、4、8、12、24 h靜態(tài)及動態(tài)疼痛NRS均顯著低于對照組[2 h靜態(tài)(3.3±0.8)分vs.(4.0±0.8)分,t=-3.922,P=0.000;4 h靜態(tài)(2.8±0.9)分vs.(3.5±0.7)分,t=-4.090,P=0.000;8 h靜態(tài)(2.5±0.6)分vs.(3.1±0.6)分,t=-4.535,P=0.000;12 h靜態(tài)(2.4±0.6)分vs.(3.0±0.4)分,t=-5.074,P=0.000;24 h靜態(tài)(2.3±0.7)分vs.(2.7±0.5)分,t=-3.239,P=0.002;2 h動態(tài)(4.1±1.0)分vs.(4.9±1.1)分,t=-3.261,P=0.002;4 h動態(tài)(3.9±0.8)分vs.(4.5±1.0)分,t=-3.001,P=0.004;8 h動態(tài)(3.5±0.8)分vs.(4.2±0.7)分,t=-3.742,P=0.000;12 h動態(tài)(3.2±0.8)分vs.(3.7±0.7)分,t=-3.350,P=0.001;24 h動態(tài)(2.6±0.7)分vs.(3.3±0.6)分,t=-4.706,P=0.000]。2組術(shù)后并發(fā)癥(惡心、嘔吐、腸梗阻、消化道出血、切口感染、肺部感染、心力衰竭)發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論 TAP阻滯能為腹腔鏡直腸癌低位前切除術(shù)提供良好的術(shù)后鎮(zhèn)痛,有利于術(shù)后恢復(fù)。
[Abstract]:Objective to explore the application value of transversus abdominis plane (TAP) block in the postoperative analgesia after low anterior resection of rectal cancer. Methods 68 cases of low anterior resection of rectal cancer in Beijing Chaoyang Hospital, November, March 2015, were selected and divided into 2 groups of 33 cases in group.TAP with random digital table method. Under the guidance of 0.375% ropivacaine 20 ml bilateral TAP block, 35 cases in the control group were injected with equal dose of normal saline by the same method. The number of 2,4,8,12,24 h static and dynamic pain digital scores (numeric rating scale, NRS) after operation, and the time of postoperative intestinal peristalsis (with bowel sounds) after operation, the time of the first step after operation, the time of postoperative hospital stay, and the circumference of postoperative hospital stay, were compared in the control group. Compared with the control group, the TAP group recovered early [(28.1 + 9.8) H vs. (35.6 + 9.4) h, t=-3.214, P=0.002], and the first step down to bed early [(1.7 + 0.6) d vs. (2 + 0.6) d, t=-2.030, P=0.046], after operation (7.1 + 1.2) (7.1 + 1.2) (7.8 + 1.7)) after the operation. H static and dynamic pain NRS were significantly lower than the control group [2 h static (3.3 + 0.8) vs. (4 + 0.8), t=-3.922, P=0.000; 4 h static (2.8 + 0.9) vs. (3.5 + 0.7), t=-4.090, P=0.000; 8 h (2.5 + 0.6) divided. S. (2.7 + 0.5), t=-3.239, P=0.002; 2 h dynamic (4.1 + 1) vs. (4.9 + 1.1), t=-3.261, P=0.002; 4 h dynamic (3.9 + 0.8) divided into vs. (4.5 + 1), t=-3.001, P=0.004; 8 h. There was no significant difference in the incidence of postoperative complications (nausea, vomiting, intestinal obstruction, gastrointestinal bleeding, incision infection, pulmonary infection, heart failure) in group P=0.000].2 (P0.05). Conclusion TAP block can provide good postoperative analgesia for laparoscopic low rectal cancer resection and it is beneficial to postoperative recovery.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京口腔醫(yī)院麻醉科;首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院麻醉科;首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院普外科;
【基金】：國家自然科學(xué)基金面上項目(81171025、81371199、81771139)
【分類號】：R614;R735.37

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