腹直肌鞘联合腹横筋膜平面神经阻滞对 脾切除患者术后恢复的影响

Combination of transversus abdominis plane block and rectus sheath block reduced postoperative pain after splenectomy

摘要:

目的 研究超声引导下腹直肌鞘联合腹横筋膜平面神经阻滞对脾切除患者术后疼痛缓解和恢复 的影响。方法 选取2018 年3 月—2018 年7 月于哈尔滨医科大学附属第二医院择期开腹脾切除术患者150 例。患者随机分为对照组、左旋布比卡因组及左旋布比卡因联合吗啡组。所有患者进行超声引导下腹直肌鞘 联合腹横筋膜平面神经阻滞，对照组注射生理盐水，左旋布比卡因组注射左旋布比卡因，左旋布比卡因联合 吗啡组注射左旋布比卡因联合吗啡。记录术中阿片类药物的用量、手术持续时间、麻醉苏醒时间、术后疼痛 评分、术后首次使用镇痛药的时间、吗啡的用量，以及术后首次排气、排便、进食及离床的时间，对患者术 后恶心呕吐发生率和患者满意度进行调查。结果 左旋布比卡因组和左旋布比卡因联合吗啡组瑞芬太尼使用 量、术后苏醒时间较对照组少（P <0.05）；左旋布比卡因联合吗啡组静息和咳嗽状态下VAS 评分低于对照 组（P <0.05），术后4 ～ 72 h，左旋布比卡因联合吗啡组静息VAS 低于左旋布比卡因组（P <0.05），左旋布比 卡因联合吗啡组咳嗽VAS 低于左旋布比卡因组（P <0.05）；对照组首次使用镇痛药的时间较左旋布比卡因组 和左旋布比卡因联合吗啡组短（P <0.05）；左旋布比卡因联合吗啡组吗啡总消耗量较对照组少（P <0.05），对 照组较左旋布比卡因组少（P <0.05）；左旋布比卡因组和左旋布比卡因联合吗啡组术后首次排气、排便和离 床时间较对照组短（P <0.05）；左旋布比卡因联合吗啡组首次进食时间、止吐药用量较对照组少（P <0.05）； 左旋布比卡因联合吗啡组满意度评分较左旋布比卡因组和对照组高（P <0.05）。结论 使用左旋布比卡因联合 吗啡进行腹直肌鞘联合腹横筋膜平面神经阻滞可以缓解术后疼痛，减少术后镇痛药的使用，并促进患者康复。

Abstract:

Objective To evaluate the effect of transversus abdominis plane block and rectus sheath block on postoperative pain relief and recovery. Methods Total 150 patients were randomized into control (C), levobupivacaine (L) and levobupivacaine plus morphine (LM) groups. All the patients received TAPB and RSB with saline, levobupivacaine or levobupivacaine plus morphine. The intraoperative opioids consumption, postoperative pain score, time to first analgesic use, postoperative recovery, including the times of first exhaust, defecation, oral intake and off-bed activity, the incidence of postoperative nausea and vomiting and antiemetics, and the satisfaction score were recorded. Results The use of remifentanil and postoperative recovery time of levobupivacaine group and levobupivacaine combined with morphine group were less than those of the control group (P < 0.05); the VAS score of levobupivacaine combined with morphine group was lower than that of the control group (P < 0.05), and the vas of levobupivacaine combined with morphine group was lower than that of levobupivacaine group (P < 0.05) 4-72 hours after operation; the cough vas of the combined morphine group was lower than that of the levobupivacaine group (P < 0.05); the time of the first use of analgesics in the control group was shorter than that in the levobupivacaine group and the levobupivacaine combined morphine group (P < 0.05); the total consumption of morphine in the levobupivacaine combined morphine group was less than that in the control group (P < 0.05), and the control group was less than that in the levobupivacaine group (P < 0.05); compared with the control group, the first time of defecation, defecation and leaving bed in the group of levobupivacaine combined with morphine was shorter (P < 0.05); the first time of eating and antiemetic dosage in the group of levobupivacaine combined with morphine was lower (P < 0.05); the satisfaction score in the group of levobupivacaine combined with morphine was higher than that in the group of levobupivacaine and the control group (P < 0.05). Conclusions The use of levobupivacaine combined with morphine for rectus sheath and transverse fascia plane nerve block can alleviate postoperative pain, reduce the use of analgesics, and promote the recovery of patients.