贵州医科大学学报

2018, v.43;No.216(09) 1084-1087+1104

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腹横肌平面阻滞对肾移植术后镇痛及肾功能的影响
Efficacy of Preoperative Transversus Abdominis Plane Block for Postoperative Pain Control and Renal Function in Renal Transplant

咸淑悦;张婧婧;李卉;王成夭;
XIAN Shuyue;ZHANG Jingjing;LI Hui;WANG Chengyao;Department of Anesthesiology,Zhongnan Hospital of Wuhan University;

摘要(Abstract):

目的:探讨腹横肌平面阻滞(TAPB)对肾移植术后的镇痛效果及肾功能的影响。方法:全麻下行同种异体肾移植术、ASA分级Ⅱ或Ⅲ级的患者40例,随机均分为TAPB组和常规镇痛组,TAPB组在全麻诱导后行超声引导下术侧TAPB,注入0. 375%罗哌卡因20 m L,两组术后均使用舒芬太病人自控静脉镇痛(PCIA),采用静脉注射曲马多50 mg行补救镇痛,维持术后48 h内VAS评分≤3分;于术后2、4、8、12、24 h时,记录两组手术患者Ramsay评分、术后24 h内PCIA舒芬太尼用量、有效按压次数、镇痛补救情况,记录患者恶心呕吐、皮肤瘙痒及呼吸抑制等不良反应;记录TAPB组相关并发症,检测术后12、24 h血浆内皮素(ET)尿素氮(BUN)、肌酐(Cr)、胱抑素C(Cys C)的浓度,同时记录尿量。结果:与常规镇痛组比较,TAPB组术后24 h PCIA舒芬太尼用量降低,有效按压次数及补救镇痛率低(P <0. 05),各时点Ramsay评分、恶心呕吐、皮肤瘙痒和呼吸抑制发生率差异无统计学意义(P> 0. 05),TAPB组未见TAPB相关并发症发生,TAPB组血浆ET、BUN、Cr、Cys C浓度降低,尿量升高(P <0. 05)。结论:TAPB可增强肾移植术患者术后镇痛效果,有助于促进肾功能恢复。
Objective: To evaluate the efficacy of preoperative transversus abdominis plane block( TAPB) for postoperative pain control and renal function in renal transplant. Methods: Forty American Society of Anesthesiologists physical status II or III patients,scheduled for general anesthesia allogenic renal transplant,were randomly divided into 2 groups( n = 20 each) : TAPB group and routine analgesia control group. After induction of anesthesia,ultrasound-guided TAPB was performed on the operated side with 0. 375% ropivacaine 20 ml in group TAPB. Patient-controlled intravenous analgesia with sufentanil was provided to all the patients after surgery. Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score within 24 h after surgery ≤3. The consumption of PCIA sufentanil within 24 hr,effective pressing times of PCIA and requirement for rescue analgesic and Ramsay score were recorded at 2,4,8,12 and 24 h after surgery. The occurrence of nausea and vomiting,pruritus and respiratory depression within 24 h after surgery were recorded.TAPB-related complications were also recorded. Venous blood samples were collected at 12 and 24 h after surgery for determination of serum endothelin( ET),blood urea nitrogen( BUN),creatinine( Cr) and cystatin C( Cys C) concentrations,and the urine volume was recorded. Results: Compared with routine analgesia control group,the amount of sufentanil consumed,effective pressing times of PCIA,requirement for rescue analgesic within 24 h after surgery decreased( P < 0. 05),and no significant change was found at same time spot in the incidence of Ramsay sedation scores,nausea and vomiting,pruritus or respiratory depression( P > 0. 05); TAPB related complications were not found in group TAPB. The serum ET,BUN,Cr,Cys C concentrations were decreased,and the urine volume increased at each time point after surgery in group TAPB( P < 0. 05). Conclusion: TAPB enhances the efficacy of postoperative analgesia and is helpful in promoting recovery of the function in patients under-went renal transplant.

关键词(KeyWords): 腹横肌平面阻滞;罗哌卡因;肾移植;镇痛;肾功能
transversus abdominis plane block;ropivacaine;kidney transplant;analgesia;renal function

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基金项目(Foundation): 国家自然科学基金项目(81601678)

作者(Author): 咸淑悦;张婧婧;李卉;王成夭;
XIAN Shuyue;ZHANG Jingjing;LI Hui;WANG Chengyao;Department of Anesthesiology,Zhongnan Hospital of Wuhan University;

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