切换至 "中华医学电子期刊资源库"
高级检索
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 Zhang2,†()   

  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:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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
[1]
Erqonenc T, Beyaz SG, Ozocak, et al. Persistent postherniorrhaphy pain following inguinal hernia repair: A cross-sectional study of prevalence, pain characteristics, and effects on quality of life[J]. Int J Surg, 2017, 46: 126-132.
[2]
孙立，陈杰，申英末. 国产新型生物疝修补片与聚丙烯产品在腹股沟疝修补术中的疗效对比[J/CD]. 中华疝和腹壁外科杂志(电子版), 2019, 13(2): 101-104.
[3]
刘子嘉，黄宇光，罗爱伦. 麻醉与加速术后康复[J]. 中华麻醉学杂志, 2016, 36(8): 909-912.
[4]
李向南，李建立，容俊芳. 腹横肌平面阻滞在临床麻醉中的研究进展[J]. 河北医药, 2018(1): 2842-2846.
[5]
Smeds S, Nienhuijs S, Kullman E, et al. Identification and management of the ilio-inguinal and ilio-hypogastric nerves in open inguinal hernia repair: benefits of self-gripping mesh[J]. Hernia, 2016, 20(1): 33-41.
[6]
Bona S, Rosati R, Opocher E, et al. Pain and quality of life after inguinal hernia surgery: a multicenter randomized controlled trial comparing lightweight vs heavyweight mesh(Supermesh Study)[J]. Updates Surg, 2017, 70(1): 77-83.
[7]
Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery[J]. Hernia, 2011, 15(3): 239-249.
[8]
张笛，谭嗣伟，梁存河, 等. 腹股沟疝手术多模式镇痛及快通道外科研究进展[J/CD]. 中华疝和腹壁外科杂志(电子版), 2014, 8(4): 62-66.
[9]
Zhang Y, ChenY, Ma L. Depression and cardiovascular disease in elderly: Current understanding[J]. J Clin Neurosci, 2017, 47: 1-5.
[10]
Ji RR, Xu ZZ, Gao YJ. Emerging targets in neuroinflammation- driven chronic pain[J]. Nat Rev Drug Discov, 2014, 13(7): 533-548.
[11]
Huang Y, Coupland NJ, Lebel RM, et al. Structural changes in hippocampal subfields in major depressive disorder: A high-field magnetic resonance imaging study[J]. Biol Psychiatry, 2013, 74(1): 62-68.
[12]
Guo P, Hu S P. Thalidomide alleviates postoperative pain and spatial memory deficit in aged rats[J]. BiomedPharmacother, 2017, 95: 583-588.
[13]
Xuling L, Yang Y, Shengmei Z, et al. Inflammatory markers in postoperative delirium(POD) and cognitive dysfunction(POCD): A meta-analysis of observational studies[J]. PLoS One, 2018, 13(4): e0195659.
[14]
姜徽，李元海，周磊, 等. 不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响[J]. 临床麻醉学杂志, 2016, 32(5): 472-475.
[15]
Wang Y, Cheng J, Yang L, et al. Ropivacaine for Intercostal Nerve Block Improves Early Postoperative Cognitive Dysfunction in Patients Following Thoracotomy for Esophageal Cancer[J]. Med Sci Monit, 2019, 25: 460-465.
[16]
李静，董补怀，蔡文博, 等. 连续腰丛阻滞降低老年患者髋关节置换术后早期认知功能障碍的发生[J]. 中南大学学报(医学版), 2018, 43(8): 858-863.
[17]
Odor P M, Chis Ster I, Wilkinson I, et al. Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study[J]. BMC Anesthesiol, 2017, 17(1): 2.
[18]
杨学林，张凯，杜颖, 等. 超声引导下腹横肌平面阻滞对老年腹股沟疝修补术患者术后疼痛的影响[J/CD]. 中华疝和腹壁外科杂志(电子版), 2017, 11(6): 441-444.
[19]
Kassiani T, Panagiota P, Athanasia T, et al. The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial[J]. Int J Surg, 2019, 63: 63-70.
[20]
牟俊英，赵博，袁泉, 等. 超声引导腹横肌平面阻滞对无张力疝修补术后患者疼痛及生存质量的影响[J]. 实用医学杂志, 2018, 34(15): 2541-2543.
[21]
Arzu K, Mehmet AE, Ulku O, et al. Ultrasound-guided transversusbdominis plane block for postoperative analgesia in living liver donors: prospective, randomized, double-blinded clinical trial[J]. Clin Anesth, 2017, 37: 103-107.
[1] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[2] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[3] 周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[4] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[5] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[6] 高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[7] 于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[8] 方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[9] 朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[10] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[11] 杨媛媛, 林贤超, 林荣贵, 陆逢春, 黄鹤光. 肌后/腹膜前补片修补巨大切口疝术后并发症防治[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 645-648.
[12] 玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.
[13] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[14] 王小琴, 汪丽, 崔建英. 无张力疝修补术治疗慢性肾功能衰竭合并腹股沟疝患者的疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 538-542.
[15] 陈金水, 陈金福, 郑开福, 祝晓路, 王铁虎, 谭俊, 李正平. 腹腔镜疝修补术治疗原发性耻骨上疝七例的临床体会[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 548-551.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号