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不同浓度布比卡因超声引导下行腹横肌平面阻滞对阑尾切除患者术后相关指标的影响
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| 篇名： | 不同浓度布比卡因超声引导下行腹横肌平面阻滞对阑尾切除患者术后相关指标的影响 |
| TITLE： | |
| 摘要： | 目的：比较不同浓度布比卡因超声引导下行腹横肌平面阻滞（TAPB）对阑尾切除患者术后相关指标的影响及安全性。方法：选择2017年3月－2018年3月我院收治的120例阑尾炎患者，按随机数字表法分为A、B、C、D组，每组各30例。所有患者手术结束即开始行超声引导下TAPB，A组患者注射0.35％布比卡因20 mL，B组患者注射0.25％布比卡因20 mL，C组患者注射0.15％布比卡因20 mL，D组患者注射0.9％氯化钠注射液20 mL，后均行静脉自控镇痛。观察4组患者行超声引导下TAPB后2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）、48 h（T6）时在静息和咳嗽状态下的疼痛视觉模拟评分（VAS），术后镇痛满意度，曲马多使用率和镇痛泵按压次数，肛门排气时间和下床时间及不良反应发生情况。结果：T2～T5时，4组患者静息状态下的VAS评分均显著高于同组T1、T6时，并在T3时达到最高值，随后逐渐降低，差异均有统计学意义（P＜0.05），T1与T6时比较差异均无统计学意义（P＞0.05）；T1～T6时，A、B、C组患者的VAS评分均显著低于D组，差异均有统计学意义（P＜0.05），但A、B、C组间比较差异均无统计学意义（P＞0.05）。T2～T4时，4组患者咳嗽状态下的VAS评分均显著高于同组T1时，并在T3、T4时达到最高值（D组为T4时），而在T5～T6时均显著低于同组T1时；T1～T6时，A、B、C组患者的VAS评分均显著低于D组，差异均有统计学意义（P＜0.05），但A、B、C组间比较差异均无统计学意义（P＞0.05）。A、B、C组患者术后镇痛满意度评分、镇痛满意度优的例数均显著高于或多于D组，曲马多使用率、镇痛泵按压次数均显著低于或少于D组，差异均有统计学意义（P＜0.05），但A、B、C组间比较差异均无统计学意义（P＞0.05）。4组患者肛门排气时间、下床时间及恶心呕吐、眩晕、瘙痒、尿潴留的发生率比较，差异均无统计学意义（P＞0.05），且所有患者均未发生局部麻醉药相关的毒性反应。结论：阑尾切除术后在超声引导下采用不同浓度布比卡因用于TAPB的镇痛效果与安全性相当，考虑到高浓度较低浓度布比卡因引起毒性反应的风险可能更高，建议选择低浓度即0.15％布比卡因。 |
| ABSTRACT： | OBJECTIVE： To compare effects and safety of ultrasound-guided transabdominis plane block （TAPB） of different concentrations of bupivacaine on related indexes in patients after appendectomy. METHODS： Totally 120 appendicitis patients selected from our hospital during Mar. 2017-Mar. 2018 were randomly divided into group A， B， C， D， with 30 cases in each group. All patients received ultrasound-guided TAPB immediately after surgery. Group A was given 0.35％ bupivacaine 20 mL intravenously； group B was given 0.25％ bupivacaine 20 mL intravenously； group C was given 0.15％ bupivacaine 20 mL intravenously； group D was given 0.9％ Sodium chloride injection 20 mL intravenously， and then given patient controlled intravenous analgesia. The VAS scores of 4 groups in resting and cough state were recorded at 2 h（T1）， 4 h（T2）， 8 h（T3）， 12 h（T4）， 24 h（T5）， 48 h（T6） after ultrasound-guided TAPB. Satisfaction degree of postoperative analgesia， the rate of tramadol use， press times of analgesic pump， anal exhaust time， the time of getting out of bed and the occurrence of ADR were observed in 4 groups. RESULTS： At T2-T5， VAS scores of 4 groups in resting were significantly lower than same group at T1 and T6； at T3， VAS scores reached the highest value and then decreased gradually， with statistical significance （P＜0.05）； there was no statistical significance at T1 and T6 （P＞0.05）. At T1-T6， VAS scores of group A， B and C were significantly lower than group D， with statistical significance （P＜0.05）； there was no statistical significance among group A， B and C （P＞0.05）. At T2-T4， VAS scores of 4 groups in cough state were significantly higher than same group at T1； at T3 and T4， VAS scores reached the highest value （group D at T4）， at T5-T6， VAS scores were lower than same group at T1； at T1-T6， VAS scores of group A， B and C were significantly lower than group D， with statistical significance （P＜0.05）， but there was no statistical significance among group A， B and C （P＞0.05）. The score of analgesia satisfaction degree and the case number excellent analgesia satisfaction degree in group A， B and C were significantly higher than or more than group D； utilization rate of tramadol and press times of analgesic pump were significantly lower than or less than group D， with statistical significance （P＜0.05）. There was no statistical significance among group A， B or C （P＞0.05）. There was no statistical significance in panal exhaust time， the time of getting out of bed， the incidence of nausea and vomiting， dizziness， pruritus or retention of urine among 4 groups （P＞0.05）. No local anesthetic related toxic reaction occurred in each group. CONCLUSIONS： After appendectomy， ultrasound-guided TAPB of different concentrations of bupivacaine have similar analgesic effect and safety. Considering high risk of toxic reation induced by high concentration of bupivacaine， low concentration as 0.15％ bupivacaine is more suitable. |
| 期刊： | 2018年第29卷第18期 |
| 作者： | 刘佳，谢科宇，谢先丰 |
| AUTHORS： | LIU Jia，XIE Keyu，XIE Xianfeng |
| 关键字： | 布比卡因；不同浓度；超声引导；腹横肌平面阻滞；阑尾切除术；镇痛；安全性 |
| KEYWORDS： | Bupivacaine； Different concentration； Ultrasound-guided； Transabdominis plane block； Appendectomy； Analgesia； Safety |
| 阅读数： | 427 次 |
| 本月下载数： | 3 次 |
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