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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 233 -237. doi: 10.3877/cma.j.issn.1674-392X.2020.03.006

所属专题： 文献；

临床论著

腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的作用
张珏颢1, 杨学林1, 张凯,2   
  1. 1. 210008　南京大学医学院附属鼓楼医院麻醉科
    2. 210008　南京大学医学院附属鼓楼医院普通外科
  • 收稿日期:2019-12-01 出版日期:2020-06-18
  • 通信作者: 张凯

Application of transversus abdominis plane block in enhanced recovery after inguinal hernia repair

Juehao Zhang1, Xuelin Yang1, Kai Zhang,2   

  1. 1. Department of Anesthesiology, The Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing 210008, China
    2. Department of General Surgery, The Drum Tower Hospital Affiliated to Nanjing University Medical College, Nanjing 210008, China
  • Received:2019-12-01 Published:2020-06-18
  • Corresponding author: Kai Zhang
  • About author:
    Corresponding author: Zhang Kai, Email:
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张珏颢, 杨学林, 张凯. 腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的作用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2020, 14(03): 233-237.

Juehao Zhang, Xuelin Yang, Kai Zhang. Application of transversus abdominis plane block in enhanced recovery after inguinal hernia repair[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(03): 233-237.

目的

探讨腹横肌平面阻滞在腹股沟疝修补术患者术后快速康复中的应用价值。

方法

选择2017年7月至2019年6月在南京大学医学院附属鼓楼医院行腹股沟疝修补术患者100例，年龄≥45岁，随机数字表法分为试验组（T组）和对照组（C组），每组各50例。T组患者全身麻醉后行患侧腹横肌平面阻滞（TAPB），给予0.375%罗哌卡因20 ml。记录所有患者术后2 h（T1）、6 h（T2）、12 h（T3）、24 h（T4）、3 d（T5）静息和运动视觉模拟疼痛（VAS）评分；记录术中镇静药物和镇痛药物使用量及术后不良反应发生情况；记录术前、术后1、3、7 d医院焦虑抑郁量表（HADS）评分结果和简易智能精神状态量表（MMSE）评分结果。

结果

T组患者术后T1、T2、T3、T4时点静息和运动VAS评分显著低于C组（P<0.05），T5时点运动VAS评分显著低于C组（P<0.05）；T组患者术中镇静药物、镇痛药物使用量较C组显著减少（P<0.05），术后恶心、呕吐发生率也显著降低（P<0.05）；T组患者术后1 d HADS评分显著低于C组（P<0.05）；T组患者术后1、3 d MMSE评分均显著低于C组（P<0.05）。

结论

TAPB可安全应用于腹股沟疝修补术患者，提供完善的术后镇痛效果，同时减少术后不良情绪的发生，预防术后认知水平的下降，符合术后快速康复的理念。

关键词: 疝，腹股沟, 疝修补术, 腹横肌平面阻滞
Objective

To observe the effect of transversus abdominis plane block (TAPB) in patients undergoing inguinal hernia repair.

Methods

From July 2017 to June 2019, one hundred patients (age more than 45 years old) undergoing inguinal hernia repair in the Drum Tower Hospital affiliated to Nanjing University Medical College were divided into either TAP block group (group T) or control group (group C), with 50 cases in each group. Group T was treated with transversus abdominis plane block after general anesthesia while group C was treated with general anesthesia. The visual analogue scale scores at rest and on movement were applied to evaluate pain degrees 2 hours after surgery (T1), 6 hours after surgery (T2), 12 hours after surgery (T3), 24 hours after surgery (T4), and 3 days after surgery (T5). The incidences of adverse reactions and the use of sedative drugs and analgesics after surgery were recorded. The hospital anxiety and depression scale (HADS) and mini-mental state examination (MMSE) were applied before surgery as well as 1, 3 and 7 days after surgery.

Results

The VAS scores during rest and movement in group T at T1, T2, T3 and T4 were lower than that in group C (P<0.05). The VAS scores on movement in group T at T5 were lower than that in group C (P<0.05). The use of sedative drugs and analgesics were significantly lower in group T than that of group C (P<0.05). The incidences of nausea and vomiting in group T were lower than those in group C (P<0.05). The scores of HADS in group T were lower than those in group C at one day after surgery (P<0.05). The scores of MMSE in group T were lower than those in group C at both one day and three days after surgery (P<0.05).

Conclusion

TAPB can be safely applied to patients undergoing inguinal hernia repair. It provides an efficacy for postoperative analgesia as well as prevents the accident of depression and cognitive dysfunction after surgery, which accords with the idea of enhanced recovery after surgery.

Key words: Hernia, inguinal, Herniorrhaphy, Transversus abdominis plane block
表1 2组患者一般情况比较
组别 例数 性别(男/女) 年龄(岁,±s) 身高(cm,±s) 体重(kg,±s) ASAⅡ/Ⅲ级(例) 手术时间(min,±s)
T组 50 48/2 66.4±10.3 170.0±6.9 67.8±8.0 29/21 42.4±16.6
C组 50 47/3 67.2±22.4 170.0±7.1 69.1±8.0 33/17 43.8±13.2
χ2/t值 ? 0.003 0.229 0.000 0.813 0.002 0.467
P值 ? 0.602 0.819 1.000 0.418 0.410 0.642
表2 2组患者镇静药物、镇痛药物使用情况比较（±s）
组别 例数 丙泊酚(mg) 瑞芬太尼(μg) 芬太尼(μg)
T组 50 114.3±50.0 176.9±80.0 276.0±105.1
C组 50 184.7±50.1 232.6±54.4 351.0±96.6
t值 ? 7.033 4.072 3.676
P值 ? 0.000 0.000 0.000
表3 2组患者术后不同时点视觉模拟评分比较（分，±s）
组别 例数 静息 运动
T1 T2 T3 T4 T5 T1 T2 T3 T4 T5
T组 50 0.3±0.4 0.5±0.5 1.0±0.5 1.2±0.5 1.5±0.5 0.6±0.7 1.2±0.6 1.8±0.7 2.0±0.6 1.8±0.5
C组 50 0.6±0.6 1.1±0.6 1.7±0.5 2.0±0.4 1.6±0.5 1.4±0.9 2.0±0.6 2.5±0.8 2.4±0.7 2.0±0.5
t值 ? 3.366 5.455 7.000 8.791 1.000 4.969 6.667 4.667 3.077 2.000
P值 ? 0.001 0.000 0.000 0.000 0.320 0.000 0.000 0.000 0.003 0.048
表4 2组患者术后不良反应发生情况比较[例（%）]
组别 例数 恶心 呕吐
T组 50 4(8.0) 2(4.0)
C组 50 12(24.0) 8(16.0)
χ2值 ? 2.381 2.000
P值 ? 0.029 0.046
表5 2组患者不同时点HADS评分及MMSE评分比较（分，±s）
组别 例数 HADS评分 MMSE评分
术前 术后1 d 术后3 d 术后7 d 术前 术后1 d 术后3 d 术后7 d
T组 50 3.7±0.8 4.5±0.8 5.3±1.0 5.4±0.9 29.0±1.0 28.1±1.6 28.3±1.1 28.4±1.2
C组 50 3.5±0.8 5.0±0.8 5.6±0.7 5.7±0.6 29.0±1.0 27.2±1.3 27.4±0.8 28.3±0.8
t值 ? 1.250 3.125 1.734 1.961 0.000 2.400 3.082 0.490
P值 ? 0.214 0.002 0.086 0.053 1.000 0.018 0.003 0.625
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