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《超声引导下腹横肌平面阻滞用于腹腔镜下全腹膜外补片疝修补术的镇痛效果-论文.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、·644·ShanghaiMedJ,2014,Vo1.37,No.8●临床麻醉●超声引导下腹横肌平面阻滞用于腹腔镜下全腹膜外补片疝修补术的镇痛效果陆捷张晓丽倪雪琚薛瑛【摘要】目的观察超声引导下腹横肌平面阻滞(TAPB)应用于腹腔镜下全腹膜外补片疝修补术(TEP)术中和术后的镇痛效果。方法采用前瞻性、随机、对照临床试验,选择单侧腹股沟斜疝患者4O例,美国麻醉医师学会分级I或Ⅱ级,既往无精神疾病和长期服用镇痛类药物史,无区域麻醉禁忌证和局部麻醉药过敏史。将患者随机分入试验组和对照组,每组2O例。患者均采用全身麻醉,试验组患者在术前30
2、min于超声定位下行双侧TAPB(每侧各注射0.375%的罗哌卡因20mL),对照组患者术前不行神经阻滞。两组术后均予静脉镇痛泵镇痛,药物为(曲马多600mg+氯诺昔康16mg)/100mL,剂量为2mL/h。术毕进入麻醉后恢复室(PACU),如疼痛视觉模拟评分(VAS评分)>3分给予芬太尼25g/次。比较两组术中和PACU的芬太尼用量,术后20min(苏醒拔除气管插管即刻)和1、4、8、24h静息和咳嗽时的疼痛VAS评分,以及术后患者的镇痛满意度。结果试验组术中和PACU的芬太尼用量均显著少于对照组(P值均3、后20min和1h静息和咳嗽时的疼痛VAS评分均显著低于对照组同时间点、同状态(P值分别4、usabdominisplaneblockinlaparoscopictotalextraperitonealherniarepairLUJie,ZHANGXiaoli,NIXuejun,XUEYing.DepartmentofAnesthesiology,ShanghaiSixthPeople’sHospi~l,ShanghaiJiaotongUniversity,Shanghai200233,ChinaCorrespondingauthor:ZHANGXiaoli,E-mail:Zhangxiaoli09@126.com[Ab5、stract]ObjectiveToinvestigatetheanalgesicefectofultrasound-guidedtransversusabdominisplaneblock(TAPB)onlaparoscopictotalexlraDeritOneaIherniarepair(TEP).MethodsFortypatientswithAmericanSocietyofAnesthesioIogists(ASA)gradeIorⅡundergoinggeneralanesthesiaforelectiveunila6、teralTEPwererecruitedinthisprospective,randomized.centrelstudy.NoneofthepatientshadhistoryofopioidorantipsychOIOgicmedication,anestheticcontraindicationorhypersensitivehistoryoflocalanesthetic.Thepatientswererandomlydividedintoexperimentgroupandcontrolgroup(n20).Thepa7、tientsintheexperimentgroupreceivedultrasoundguidedbilateralTAPBwith0.375%ropivacaine20mLbeforesurgery,whileTAPBwasnotperformedincontrolgroup.Allthepatientsreceivedpatient—cOntrOlledanalgesia(PCA,tramadol600mgandIornoxicam16mgdilutedto100mL,2mL/h).Oncethevisualanalogsc8、ale(VAS)scorewasover3inpostanesthesiacareunit(PACU),25Pgfentanylwasinjectedintravenously.Totalamountoffentanylwithinandafter
3、后20min和1h静息和咳嗽时的疼痛VAS评分均显著低于对照组同时间点、同状态(P值分别4、usabdominisplaneblockinlaparoscopictotalextraperitonealherniarepairLUJie,ZHANGXiaoli,NIXuejun,XUEYing.DepartmentofAnesthesiology,ShanghaiSixthPeople’sHospi~l,ShanghaiJiaotongUniversity,Shanghai200233,ChinaCorrespondingauthor:ZHANGXiaoli,E-mail:Zhangxiaoli09@126.com[Ab5、stract]ObjectiveToinvestigatetheanalgesicefectofultrasound-guidedtransversusabdominisplaneblock(TAPB)onlaparoscopictotalexlraDeritOneaIherniarepair(TEP).MethodsFortypatientswithAmericanSocietyofAnesthesioIogists(ASA)gradeIorⅡundergoinggeneralanesthesiaforelectiveunila6、teralTEPwererecruitedinthisprospective,randomized.centrelstudy.NoneofthepatientshadhistoryofopioidorantipsychOIOgicmedication,anestheticcontraindicationorhypersensitivehistoryoflocalanesthetic.Thepatientswererandomlydividedintoexperimentgroupandcontrolgroup(n20).Thepa7、tientsintheexperimentgroupreceivedultrasoundguidedbilateralTAPBwith0.375%ropivacaine20mLbeforesurgery,whileTAPBwasnotperformedincontrolgroup.Allthepatientsreceivedpatient—cOntrOlledanalgesia(PCA,tramadol600mgandIornoxicam16mgdilutedto100mL,2mL/h).Oncethevisualanalogsc8、ale(VAS)scorewasover3inpostanesthesiacareunit(PACU),25Pgfentanylwasinjectedintravenously.Totalamountoffentanylwithinandafter
4、usabdominisplaneblockinlaparoscopictotalextraperitonealherniarepairLUJie,ZHANGXiaoli,NIXuejun,XUEYing.DepartmentofAnesthesiology,ShanghaiSixthPeople’sHospi~l,ShanghaiJiaotongUniversity,Shanghai200233,ChinaCorrespondingauthor:ZHANGXiaoli,E-mail:Zhangxiaoli09@126.com[Ab
5、stract]ObjectiveToinvestigatetheanalgesicefectofultrasound-guidedtransversusabdominisplaneblock(TAPB)onlaparoscopictotalexlraDeritOneaIherniarepair(TEP).MethodsFortypatientswithAmericanSocietyofAnesthesioIogists(ASA)gradeIorⅡundergoinggeneralanesthesiaforelectiveunila
6、teralTEPwererecruitedinthisprospective,randomized.centrelstudy.NoneofthepatientshadhistoryofopioidorantipsychOIOgicmedication,anestheticcontraindicationorhypersensitivehistoryoflocalanesthetic.Thepatientswererandomlydividedintoexperimentgroupandcontrolgroup(n20).Thepa
7、tientsintheexperimentgroupreceivedultrasoundguidedbilateralTAPBwith0.375%ropivacaine20mLbeforesurgery,whileTAPBwasnotperformedincontrolgroup.Allthepatientsreceivedpatient—cOntrOlledanalgesia(PCA,tramadol600mgandIornoxicam16mgdilutedto100mL,2mL/h).Oncethevisualanalogsc
8、ale(VAS)scorewasover3inpostanesthesiacareunit(PACU),25Pgfentanylwasinjectedintravenously.Totalamountoffentanylwithinandafter
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