本文選題：超聲引導(dǎo) + 腹橫肌平面��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：評(píng)價(jià)超聲引導(dǎo)腹橫肌平面阻滯用于腹腔鏡膽囊切除患者的術(shù)后鎮(zhèn)痛效果。 方法：60例腹腔鏡膽囊切除患者，隨機(jī)分為兩組，每組30例，分別為腹橫肌平面阻滯組(transversus abdominis plane，TAP組)和患者自控靜脈鎮(zhèn)痛組（patient-controlled intravenousanalgesia group，PCIA組）。兩組患者均采用靜吸復(fù)合全身麻醉。手術(shù)結(jié)束后，TAP組接受超聲引導(dǎo)腹橫肌平面阻滯，每點(diǎn)注射0.25鹽酸羅哌卡因注射液20ml，PCIA組采用1g/ml枸櫞酸舒芬太尼注射液靜脈自控鎮(zhèn)痛。應(yīng)用視覺模擬評(píng)分(visual analogue scale，，VAS）法評(píng)估疼痛強(qiáng)度和術(shù)后惡心嘔吐（post-operative nausea and vomiting，PONV）程度。VAS≥4分，給予鎮(zhèn)痛補(bǔ)救藥物氟比洛芬酯注射液50mg鎮(zhèn)痛，出現(xiàn)中度及以上程度PONV，靜脈注射鹽酸甲氧氯普胺注射液10mg止吐。記錄手術(shù)時(shí)間，麻醉誘導(dǎo)、麻醉維持藥物用量；于出恢復(fù)室時(shí)、術(shù)后6h時(shí)、術(shù)后24h時(shí)記錄靜息VAS評(píng)分；比較兩組患者出恢復(fù)室時(shí)、術(shù)后6h時(shí)、術(shù)后24h時(shí)疼痛強(qiáng)度；記錄兩組患者恢復(fù)室內(nèi)、出恢復(fù)室-術(shù)后6h、術(shù)后6h-24h三個(gè)時(shí)段鎮(zhèn)痛補(bǔ)救例數(shù)；比較兩組患者PONV、呼吸抑制、皮膚瘙癢等不良反應(yīng)的發(fā)生率；觀察TAP組局麻藥中毒、腹腔內(nèi)臟器損傷等腹橫肌平面阻滯操作并發(fā)癥的發(fā)生率。 結(jié)果：兩組患者手術(shù)時(shí)間、麻醉誘導(dǎo)用藥量、麻醉維持用藥量差異無統(tǒng)計(jì)學(xué)意義；TAP組鎮(zhèn)痛效果顯著，出恢復(fù)室時(shí)、術(shù)后6h時(shí)、術(shù)后24h時(shí)，兩組患者疼痛強(qiáng)度差異無統(tǒng)計(jì)學(xué)意義；恢復(fù)室內(nèi)、出恢復(fù)室-術(shù)后6h、術(shù)后6h-24h三個(gè)時(shí)段，兩組鎮(zhèn)痛補(bǔ)救發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。術(shù)后24小時(shí)內(nèi)，與PCIA組相比，TAP組PONV發(fā)生率明顯減少（p0.05），差異有統(tǒng)計(jì)學(xué)意義。兩組患者術(shù)后均未見呼吸抑制，皮膚瘙癢等藥物不良反應(yīng)，TAP組未發(fā)現(xiàn)腹腔內(nèi)臟器損傷、局麻藥中毒等操作并發(fā)癥。 結(jié)論：超聲引導(dǎo)TAP阻滯具有良好的腹腔鏡膽囊切除術(shù)后鎮(zhèn)痛作用，并可降低術(shù)后惡心嘔吐發(fā)生率，是一項(xiàng)安全、有效、并發(fā)癥少的術(shù)后鎮(zhèn)痛措施。
[Abstract]:Objective: to evaluate the analgesic effect of abdominal transverse muscle block guided by ultrasound in patients undergoing laparoscopic cholecystectomy. Methods Sixty patients with laparoscopic cholecystectomy were randomly divided into two groups: 30 patients in each group (n = 30) and patient-controlled intravenousanalgesia group (n = 30). Both groups were treated with intravenous inhalation combined with general anesthesia. After the operation, the tap group received ultrasound guided abdominal transverse muscle block, and 20 ml ropivacaine hydrochloride injection was injected into each point. PCIA group received 1g/ml citrate sufentanil injection for patient-controlled analgesia. Visual analogue scale (VAS) was used to evaluate the pain intensity and the degree of postoperative nausea and vomiting post-operative nausea and vomiting.VAS 鈮

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