腹横筋膜阻滞联合布托啡诺超前镇痛在日间腹腔镜手术中的应用效果

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摘要目的探讨腹横筋膜阻滞联合布托啡诺超前镇痛在日间腹腔镜手术中的应用效果。方法选取2021年1月1日至4月10日在赣州市人民医院行日间腹腔镜下胆囊切除的手术患者90 例为研究对象，按照随机数字表分为研究组（45 例）和对照组（45 例）。研究组在麻醉诱导前10 min 经鼻滴入0.01 mg/kg 布托啡诺，对照组则滴入同等剂量的生理盐水，手术结束后，两组患者在超声引导下行双侧腹横筋膜阻滞。比较两组的瑞芬太尼用量、手术时间、麻醉苏醒时间、拔管时间及复苏室停留时间；分别在术后2、4、6、12 h 及离院时（T1～T5）对患者进行术后镇痛评分；统计术后镇痛期间曲马多追加人次、不良反应发生率及患者镇痛满意度和未按时出院率。结果两组患者瑞芬太尼用量、手术时间、苏醒时间、拔管时间、复苏室停留时间比较，差异无统计学意义（P＞0.05）。研究组T1～T4 时视觉模拟量表（VAS）评分低于对照组，差异有统计学意义（P＜0.05）。研究组曲马多追加次数少于对照组，研究组满意度高于对照组，研究组术后恶心呕吐、嗜睡发生率低于对照组，差异有统计学意义（P＜0.05）。两组的未按时出院率比较，差异无统计学意义（P＞0.05）。结论超声引导下腹横筋膜阻滞联合布托啡诺经鼻给药超前镇痛适用于日间腹腔镜下胆囊切除术的镇痛，能够提供良好的镇痛效果，且不影响患者的苏醒时间，安全性较高。

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	黄毅升
	黄明辉
	钟宝琳

关键词 ：腹横筋膜阻滞, 右美托咪定, 布托啡诺, 超前镇痛, 日间手术

Abstract：Objective To observe effect of transverse abdominal fascia block combined with Butorphanol preemptive analgesia in daytime laparoscopic surgery. Methods A total of 90 patients who underwent daytime laparoscopic cholecystectomy in Ganzhou People′s Hospital from January 1, 2021 to April 10, 2021 were selected as the research subjects, and were divided into study group (45 cases) and control group (45 cases) according to random number table. In the study group, 0.01 mg/kg Butorphanol was given intranasally 10 min before induction of anesthesia, while in the control group, the same dose of normal saline was given intranasally. After surgery, bilateral transverse abdominal fascia was blocked under ultrasound guidance in both groups. The dosage of Remifentanil, operation time, anesthesia time, extubation time and stay time in resuscitation room were compared between the two groups. Postoperative analgesia scores were scored at 2, 4, 6, 12 h after surgery and at the time of discharge (T1-T5). The number of additional tramadol patients, the incidence of adverse reactions, analgesic satisfaction and the rate of untimely discharge during postoperative analgesia were analyzed. Results There were no significant differences in Remifentanil dosage, operation time, recovery time, extubation time and stay time in resuscitation room between two groups (P＞0.05). The visual analog scale (VAS)score of the study group at T1-T4 were lower than those of the control group, and the differences were statistically significant (P＜0.05). The additional number of Tramadol in the study was less than that in the control group, the satisfaction of study group was higher than that of the control group, and the incidence of postoperative nausea, vomiting and lethargy in the study group was lower than the control group, and the differences were statistically significant (P＜0.05).There was no significant difference in the rate of untimely discharge between the two groups (P＞0.05). Conclusion Ultrason-guided transverse abdominal fascia block combined with nasal preemptive analgesia of butorphano is suitable for analgesia in daytime laparoscopic cholecystectomy, which can provide a good analgesic effect and does not affect the recovery time of patients, with high safety.

Key words： Transversus abdominis plane block;Dexmedetomidine Butorphanol Preemptive analgesia Day surgery

基金资助:江西省赣州市指导性科技计划任务（GZ2020ZSF 138）；江西省赣州市卫生健康委员会市级科研计划项目（2020-2-18）

引用本文:

黄毅升；黄明辉；钟宝琳. 腹横筋膜阻滞联合布托啡诺超前镇痛在日间腹腔镜手术中的应用效果[J]. 中国当代医药, 2021, 28(28): 118-121.
HUANG Yi-sheng；HUANG Ming-hui；ZHONG Bao-lin. Effect of transverse abdominal fascia block combined with Butorphanol preemptive analgesia in daytime laparoscopic surgery. 中国当代医药, 2021, 28(28): 118-121.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I28/118

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