双侧腹横肌平面阻滞在腹腔镜食管裂孔疝修补术后快速康复中的应用

doi:10.3877/cma.j.issn.1674-6899.2016.01.008

中华胃食管反流病电子杂志 ›› 2016, Vol. 03 ›› Issue (01) : 23 -26. doi: 10.3877/cma.j.issn.1674-6899.2016.01.008

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双侧腹横肌平面阻滞在腹腔镜食管裂孔疝修补术后快速康复中的应用

闫磊¹, 石文剑¹, 喇宏玲¹, 徐桂萍¹^,^†(

)

^1. 830000　乌鲁木齐，新疆维吾尔自治区人民医院麻醉科

收稿日期:2015-09-29 出版日期:2016-02-15
通信作者: 徐桂萍
基金资助:
新疆维吾尔自治区人民医院院内项目(20140104)

The application of bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair

Lei Yan¹, Wenjian Shi¹, Hongling La¹, Guiping Xu¹^,^†()

^1. Department of Anesthesiology, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumuqi 830001, China

Received:2015-09-29 Published:2016-02-15
Corresponding author: Guiping Xu
About author:
Corresponding author: Xu Guiping, Email: nmyanlei@yeah.net

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目的

探讨超声引导双侧腹横肌平面(transverses abdominis plane，TAP)阻滞在腹腔镜食管裂孔疝修补术后快速康复中的可行性和有效性。

方法

选取2014年10月至2015年10月，新疆维吾尔自治区人民医院择期行腹腔镜食管裂孔疝修补术患者60例随机分为三组：特耐组患者20例，术毕患者每8 h肌注特耐40 mg至24 h；TAP组患者20例，术毕即可行超声引导下双侧肋缘下TAP阻滞；特耐联合TAP组患者20例，术毕患者每8 h肌注特耐40 mg至24 h，并术毕即可行超声引导下双侧肋缘下TAP阻滞。超声引导下双侧TAP阻滞，每侧给予0.25%盐酸罗哌卡因40 ml。观察并记录三组患者术后2、4、6、8、12和24 h时静息视觉模拟(VAS)评分；记录患者对术后镇痛的满意度，有无局麻药中毒、恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应。

结果

特耐联合TAP组与其他两组比较，术后各时点VAS评分明显降低(P<0.05)，患者术后镇痛满意度较高(P<0.05)，无不良反应发生。

结论

特耐联合超声引导双侧肋缘下腹横肌平面阻滞在腹腔镜食管裂孔疝修补术后的镇痛效果确切，可有效促进患者快速康复，值得推广。

关键词: 疝，食管裂孔, 腹横肌平面阻滞, 术后镇痛, 快速康复

Objective

To explore the feasibility and effectiveness of Ultrasound-guided bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair.

Methods

From October 2014 to October 2015, the patients in People′s Hospital of Xinjiang Uygur Autonomous Region undergoing selective laparoscopic hiatal hernia repair were randomly divided into 3 groups(n=20). After the operation, Ultrasound-guided bilateral transverse abdominal plane block and intramuscular parecoxib were performed.According to the grouping situation, The patients of ultrasound-guided bilateral transverse abdominal plane block were administrated with 0.25% ropivacaine hydrochloride 40 ml.The patients of intramuscular parecoxib were administrated 40 mg parecoxib every 8 to 24 hours.Visual analog pain score(VAS)at 2, 4, 6, 8, 12 and 24 h after operation were compared.The satisfaction of postoperative analgesia and the adverse reactions such as local anesthetics poisoning, nausea and vomiting, respiratory depression and skin pruritus were compared.

Results

The VAS score of the TAP block group combined with parecoxib in all the time were Significantly lower than the other two groups, and The satisfaction of postoperative analgesia is higher(P<0.05). No adverse reaction occurred.

Conclusion

Ultrasound-guided bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair combined with parecoxib had exact analgesic effect, could effectively promote the patients′ rapid recovery, and were worth promoting.

Key words: Hernia, hiatal, Transverses abdominis plane block, Postoperative analgesia, Enhanced recovery

表1 3组患者一般资料(±s)

组别	例数	性别(男/女，例)	年龄(岁)	身高(cm)	体重(kg)
特耐组	20	7/13	45.2±5.6	165.6±9.5	65.8±8.9
TAP组	20	6/14	43.6±7.5	163.9±10.8	67.1±8.1
特耐联合TAP组	20	7/13	46.1±4.7	165.2±7.3	65.3±10.2

表1 3组患者一般资料(±s)

组别	例数	性别(男/女，例)	年龄(岁)	身高(cm)	体重(kg)
特耐组	20	7/13	45.2±5.6	165.6±9.5	65.8±8.9
TAP组	20	6/14	43.6±7.5	163.9±10.8	67.1±8.1
特耐联合TAP组	20	7/13	46.1±4.7	165.2±7.3	65.3±10.2

表2 3组患者不同时点VAS评分(分，±s)

组别	例数	2 h	4 h	8 h	12 h	24 h
特耐组	20	2.2±1.1	2.8±1.5	3.1±0.3	4.2±1.1	5.8±1.0
TAP组	20	2.0±0.9	2.3±1.6	3.0±0.8	3.9±1.7	5.2±1.4
特耐联合TAP组	20	1.1±0.3^*	1.3±0.5^*	1.3±1.2^*	2.5±0.9^*	3.0±1.1^*

表2 3组患者不同时点VAS评分(分，±s)

组别	例数	2 h	4 h	8 h	12 h	24 h
特耐组	20	2.2±1.1	2.8±1.5	3.1±0.3	4.2±1.1	5.8±1.0
TAP组	20	2.0±0.9	2.3±1.6	3.0±0.8	3.9±1.7	5.2±1.4
特耐联合TAP组	20	1.1±0.3^*	1.3±0.5^*	1.3±1.2^*	2.5±0.9^*	3.0±1.1^*

表3 三组患者术后镇痛的满意度及恶心呕吐的比较

组别	例数	术后镇痛的满意度(%)	恶心(例)
特耐组	20	78	2
TAP组	20	82	1
特耐联合TAP组	20	96^*	1

表3 三组患者术后镇痛的满意度及恶心呕吐的比较

组别	例数	术后镇痛的满意度(%)	恶心(例)
特耐组	20	78	2
TAP组	20	82	1
特耐联合TAP组	20	96^*	1

1	Ljungqvist O. ERAS-enhanced recovery after surgery：moving evidence-based perioperative care to practice[J]. J Parenter Enteral Nutr, 2014, 38(5): 559-566.
2	Baeriswyl M,Kirkham KR,Kern C. The Analgesic Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Adult Patients：A Meta-Analysis[J]. Anesth Analg, 2015, 121(6): 1640-1654.
3	张成, 克里木·阿不都热依木, 王志. 腹腔镜食管裂孔疝修补术和胃底折叠术的围手术期处理[J/CD]. 中华胃食管反流病电子杂志, 2014, 1(1): 12-14.
4	Hebbard P,Royse C. Audit of transverse abdominus plane block for analgesia following caesarean section[J]. Anaesthesia, 2008, 63(12): 1382.
5	Tan M,Law LS,Gan TJ.Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways[J]. Can J Anaesth, 2015, 62(2): 203-218.
6	Bona S,Molteni M,Rosati R. Introducing an enhanced recovery after surgery program in colorectal surgery：a single center experience[J]. World J Gastroenterol, 2014, 14；20(46): 17578-17587.
7	田文, 马冰. 腹腔镜食管裂孔疝诊断和治疗[J/CD]. 中华胃食管反流病电子杂志, 2014, 1(1): 7-8.
8	Mashhadi Z,Boeglin WE,Brash AR.Robust inhibitory effects of conjugated linolenic acids on a cyclooxygenase-related linoleate 10S-dioxygenase：Comparison with COX-1 and COX-2[J]. Biochim Biophys Acta, 2015, 1851(10): 1346-1352.
9	McLeod RS,Aarts MA,Chung F. Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle[J]. Ann Surg, 2015, 262(6): 1016-1025.
10	Barrington MJ,Ivanusic JJ,Rozen WM.Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block：a cadaveric study[J]. Anaesthesia, 2009, 64(7): 745-750.

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The application of bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair

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The application of bilateral transverse abdominal plane block in the enhanced recovery after laparoscopic hiatal hernia repair