[1]王 芳.超声引导ESP阻滞联合TAP阻滞对腹腔镜胆囊切除术术后镇痛效果的影响[J].医学信息,2023,36(23):80-83.[doi:10.3969/j.issn.1006-1959.2023.23.020]
　WANG Fang.Effect of Ultrasound-guided ESP Block Combined with TAP Block on Postoperative Analgesia After Laparoscopic Cholecystectomy[J].Journal of Medical Information,2023,36(23):80-83.[doi:10.3969/j.issn.1006-1959.2023.23.020]
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超声引导ESP阻滞联合TAP阻滞对腹腔镜胆囊切除术术后镇痛效果的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年23期
页码:
80-83
栏目:
论著
出版日期:
2023-12-01

文章信息/Info

Title:
Effect of Ultrasound-guided ESP Block Combined with TAP Block on Postoperative Analgesia After Laparoscopic Cholecystectomy
文章编号:
1006-1959（2023）23-0080-04
作者:
王 芳
（佳木斯市中心医院麻醉科，黑龙江 佳木斯 154002）
Author(s):
WANG Fang
(Department of Anesthesiology,Jiamusi Central Hospital,Jiamusi 154002,Heilongjiang,China)
关键词:
腹腔镜胆囊切除术; 竖脊肌平面阻滞; 腹横肌平面阻滞; 超声引导; 血流动力学; 术后镇痛
Keywords:
Laparoscopic cholecystectomy; Erector spinae plane block; Transversus abdominis plane block; Ultrasound-guided; Hemodynamics; Postoperative analgesia
分类号:
R614
DOI:
10.3969/j.issn.1006-1959.2023.23.020
文献标志码:
A
摘要:
目的 探讨超声引导竖脊肌平面（ESP）阻滞联合腹横肌平面（TAP）阻滞在腹腔镜胆囊切除术（LC）中的镇痛效果。方法 以2020年7月-2022年7月佳木斯市中心医院拟行LC治疗的66例患者为研究对象，依照随机数字表法分为TAP组（33例）与ESP+TAP组（33例）。TAP组于术前行超声引导TAP阻滞，ESP+TAP组则于术前采用超声引导ESP联合TAP阻滞，比较两组围术期各时间点[术前（T0）、气管插管时（T1）、手术30 min（T2）、手术结束时（T3）]的血流动力学指标[心率（HR）、平均动脉压（MAP）]、镇痛效果[疼痛视觉模拟评分（VAS）]、术后镇痛泵按压次数、镇痛泵药液输注总量及麻醉相关并发症。结果 ESP+TAP组围术期各时点HR、MAP比较，差异无统计学意义（P＞0.05），而TAP组围术期各时点HR、MAP比较，差异有统计学意义（P＜0.05），有T1、T2、T3时点HR、MAP均高于ESP+TAP组（P＜0.05）。ESP+TAP组术后2、6 h静、动态VAS评分均低于TAP组（P＜0.05）。ESP+TAP组术后24 h内镇痛泵按压次数、镇痛泵药液输注总量均少于TAP组（P＜0.05）。ESP+TAP组麻醉相关并发症发生率低于TAP组（P＜0.05）。结论 超声引导ESP联合TAP阻滞可有效维持LC患者的围术期血流动力学稳定，且术后镇痛效果良好，可减少镇痛泵按压次数及其药物用量，降低患者的麻醉并发症风险。
Abstract:
Objective To investigate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block combined with transversus abdominis plane (TAP) block in laparoscopic cholecystectomy (LC).Methods A total of 66 patients who underwent LC in Jiamusi Central Hospital from July 2020 to July 2022 were divided into TAP group (33 patients) and ESP+TAP group (33 patients) according to the random number table method. The TAP group received ultrasound-guided TAP block before operation, and the ESP+TAP group received ultrasound-guided ESP combined with TAP block before operation. The hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)] at different time points [preoperative (T0), tracheal intubation (T1), 30 min after operation (T2), end of operation (T3)], analgesic effect [visual analogue scale (VAS)], postoperative analgesia pump pressing times, total infusion volume of analgesic pump and anesthesia-related complications were compared between the two groups.Results There were no significant differences in HR and MAP at each time point during the perioperative period in the ESP+TAP group (P>0.05), while there were significant differences in HR and MAP at each time point during the perioperative period in the TAP group (P<0.05), and the HR and MAP at T1, T2 and T3 were higher than those in the ESP+TAP group (P<0.05). The static and dynamic VAS scores of the ESP+TAP group were lower than those of the TAP group at 2 and 6 h after operation (P<0.05). The pressing times of analgesic pump and the total amount of infusion of analgesic pump in ESP+TAP group were less than those in TAP group within 24 h after operation (P<0.05). The incidence of anesthesia-related complications in the ESP+TAP group was lower than that in the TAP group (P<0.05).Conclusion Ultrasound-guided ESP combined with TAP block can effectively maintain the perioperative hemodynamic stability of LC patients, and the postoperative analgesic effect is good. Meanwhile, it can reduce the number of analgesic pump compressions and the dosage of drugs, and reduce the risk of anesthesia complications.

参考文献/References:

[1]高元朝,张海静,朱长真,等.超声引导下单次竖脊肌平面阻滞在胸腔镜肺叶切除术中镇痛效果的研究[J].北京医学,2022,44(1):40-43.[2]陈爱芳,罗苹,项余华,等.超声引导竖脊肌平面阻滞与胸椎旁神经阻滞用于胸腔镜肺叶切除术患者术后镇痛的临床对比研究[J].中国地方病防治杂志,2020,35(1):90-93.[3]简春芳,沈熠,傅杭祥,等.超声引导下竖脊肌平面阻滞与肋间神经阻滞对胸腔镜下肺叶切除术患者术后镇痛效果的比较[J].中华疼痛学杂志,2021,17(5):528-533.[4]李真,王瑞.超声引导下竖脊肌平面阻滞和胸椎旁神经阻滞应用于胸腔镜下肺叶切除术中血流动力学变化及术后联合PCIA的效果观察[J].贵州医药,2021,45(8):1213-1214.[5]李静,赵艳波.超声引导下腹横平面阻滞对腹腔镜胆囊切除术后镇痛效果的影响[J].中国药物与临床,2020,20(10):1705-1706.[6]周新,王胜斌.切口局麻药浸润和超声引导下腹横肌平面阻滞对腹腔镜胆囊切除患者术后恢复的影响[J].肝胆外科杂志,2020,28(4):297-299.[7]胡菲娅,徐慧.超声引导下竖脊肌平面阻滞用于老年腰椎后路手术患者术后镇痛的效果[J].广东医学,2020,41(24):2582-2585.[8]周桥灵,刘洪珍,赖晓红,等.超声引导下单次竖脊肌平面阻滞用于老年患者术后镇痛的效果[J].临床麻醉学杂志,2018,34(11):1080-1083.[9]张宇帆,赵栋,许多嘉,等.超声引导竖脊肌平面阻滞对胸腔镜肺叶切除患者术后镇痛和细胞免疫功能的影响[J].中国内镜杂志,2020,26(9):41-48.[10]涂光洁,吴志林,王洁,等.超声引导下T5椎旁神经阻滞联合竖脊肌平面阻滞应用于胸腔镜下肺叶切除术中的效果[J].国际麻醉学与复苏杂志,2020,41(11):1039-1042.[11]林晓峰,罗德兴,惠强.B超引导下多点腹横肌平面阻滞联合右美托咪定对腹腔镜胆囊切除术患者术后恢复的影响[J].广东医学,2019,40(7):990-993.[12]王晓霞,黄太满,郭志鹏,等.斜肋下腹横肌平面阻滞用于腹腔镜胆囊切除术后的镇痛研究[J].安徽医药,2018,22(3):425-429.[13]张媛,方兆晶,单涛,等.超声引导下竖脊肌平面阻滞对胸腔镜肺叶切除术患者术后肺功能的影响[J].临床麻醉学杂志,2020,36(1):17-20.[14]杨健,马铃,邱艳.超声引导下单次竖脊肌平面阻滞对胸腔镜肺叶切除患者术后镇痛的影响[J].中国医师进修杂志,2019(6):481-484.[15]张超,王进全,陈杨.超声引导下ESP阻滞联合PCIA对胸腔镜下肺癌术后镇痛效果的分析[J].癌症进展,2018,16(8):967-969,1041.[16]夏玉中,卜慧莲,张洁,等.超声引导竖脊肌平面阻滞用于胸腔镜肺叶切除术患者术后镇痛的效果:与胸椎旁神经阻滞比较[J].中华麻醉学杂志,2018,38(3):332-335.[17]周军,刘胜群,崔明珠,等.超声引导竖脊肌平面阻滞对老年患者单孔胸腔镜下肺癌根治术镇痛效果和应激反应的影响[J].重庆医学,2019,48(7):1213-1215.[18]王智渊,沈子珒,王海滨,等.全麻联合超声引导下腹横肌平面阻滞对腹腔镜胆囊切除术后镇痛的影响[J].腹腔镜外科杂志,2019,24(6):445-448.[19]夏玉中,邢飞,卜慧莲,等.麻醉因素对胸腔镜肺叶切除术患者术后早期转归的影响:超声引导竖脊肌平面阻滞联合全身麻醉的效果[J].中华麻醉学杂志,2018,38(11):1331-1334.[20]蔡少彦,陈超,张蕾,等.超声引导ESP阻滞、TAP阻滞在腹腔镜胆囊切除术术后镇痛中的应用对比观察[J].山东医药,2020,60(18):92-95.

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更新日期/Last Update: 1900-01-01