CAJ | 학술논문

目的：探讨超声引导改良肋缘下腹横肌阻滞对腹腔镜胆囊切除术患者术中术后镇痛效果的影响。方法全麻下行腹腔镜胆囊切除术60例，随机分为两组。麻醉诱导后一组在超声引导下行改良肋缘下入路的双侧腹横肌平面（ TAP）阻滞，注入0．5％罗哌卡因（0．8 mL／kg，A组），另一组全麻后未行TAP阻滞（B组）。两组术后均应用患者静脉自控镇痛（PCIA）进行镇痛。记录两组手术中瑞芬太尼的用量，手术结束时除去喉罩时的平均动脉压（MAP）和心率（HR），术后2、6、24 h视觉模拟疼痛（ VAS）评分，PCIA泵术后36 h总用药量和自控镇痛有效按压次数及镇痛期间不良反应的发生情况。结果与B组比较，A组术中瑞芬太尼的用量明显减少（P＜0．05），除去喉罩时MAP、HR波动明显减小（P＜0．05），术后2、6 h VAS评分A组明显低于B组（P＜0．05），PCIA总用药量和有效按压次数A组明显少于B组（P＜0．05），A组镇痛期间不良反应发生也明显少于B组。结论超声引导改良肋缘下TAP阻滞能为腹腔镜胆囊切除术患者提供良好的术中及术后镇痛。
목적：탐토초성인도개량륵연하복횡기조체대복강경담낭절제술환자술중술후진통효과적영향。방법전마하행복강경담낭절제술60례，수궤분위량조。마취유도후일조재초성인도하행개량륵연하입로적쌍측복횡기평면（ TAP）조체，주입0．5％라고잡인（0．8 mL／kg，A조），령일조전마후미행TAP조체（B조）。량조술후균응용환자정맥자공진통（PCIA）진행진통。기록량조수술중서분태니적용량，수술결속시제거후조시적평균동맥압（MAP）화심솔（HR），술후2、6、24 h시각모의동통（ VAS）평분，PCIA빙술후36 h총용약량화자공진통유효안압차수급진통기간불량반응적발생정황。결과여B조비교，A조술중서분태니적용량명현감소（P＜0．05），제거후조시MAP、HR파동명현감소（P＜0．05），술후2、6 h VAS평분A조명현저우B조（P＜0．05），PCIA총용약량화유효안압차수A조명현소우B조（P＜0．05），A조진통기간불량반응발생야명현소우B조。결론초성인도개량륵연하TAP조체능위복강경담낭절제술환자제공량호적술중급술후진통。
Objective To investigate the effect of ultrasound-guided improved subcostal transversus abdominis plane ( TAP) block on intraoperative and postoperative analgesia in patients undergoing laparoscopic cholecystectomy .Methods Sixty patients un-dergoing laparoscopic cholecystectomy were randomly allocated into 2 groups (30 cases each):group A and group B.After induction of anesthesia, ultrasound-guided improved subcostal TAP block was performed and 0.5%ropivacaine (0.8 mL/kg) was injected in group A, while nothing was done in group B ( matched group ) .All patients received patient controlled intravenous analgesia ( PCIA) after operation.The consumption of remifentanil during operation were recorded .The mean arterial pressure (MAP), heart rate (HR) were recorded on the end of surgery and the extraction of laryngeal mask (LAM).Pain visual analog scale (VAS) scores at 2, 6, 24 h after operation, the dosage of 36 h patient controlled intravenous analgesia ( PCIA) and frequencies of PCIA effective pressing were recor-ded.The adverse reactions were also recorded .Results Compared with group B, the consumption of remifentanil during operation in group A were significantly lower (P<0.05), the MAP and HR in group A maintain even stable during the extraction of LAM (P<0.05), VAS at 2, 6 h after operation were significantly lower (P<0.05).The dosage of 36 h PCIA and the frequencies of PCIA ef-fective pressing of group B were much more than those of group A (all P<0.05), the adverse reactions in group B were significantly higher than those in group A (P<0.05).Conclusion By using ultrasound-guided improved subcostal TAP block can provided a bet-ter intraoperative and postoperative analgesic efficacy in patients undergoing laparoscopic cholecystectomy .