超声引导下TAP神经阻滞在胃癌根治术中的应用

doi:10.3760/cma.j.cn441417-20241119-12013

摘要/Abstract

摘要：

目的　观察超声引导下腹横肌平面（transversus abdominis plane，TAP）神经阻滞在胃癌根治术中的应用效果。方法　选取2021年1月至2023年10月在西电集团医院行胃癌根治术的104例患者进行随机对照试验。采用随机数字表法将其分为对照组和试验组，各52例。对照组男29例，女23例，年龄（50.81±5.75）岁，体重（61.05±7.53）kg，体重指数（23.82±3.14）kg·m^-²，手术时间（124.35±10.71）min。试验组男27例，女25例，年龄（50.56±5.49）岁，体重（61.44±7.70）kg，体重指数（23.63±3.21）kg·m^-²，手术时间（124.12±10.35）min。试验组超声引导下TAP神经阻滞联合全身麻醉，对照组单纯全身麻醉。比较两组术中麻醉药物用量，围手术期指标（术后苏醒时间、下床时间、术后首次补充镇痛时间），术后1 h、4 h、8 h视觉模拟量表（Visual Analog Scale，VAS）评分和Bruggrmann舒适度评分（Bruggrmann Comfort Score，BCS），术前、术后24 h炎症因子和应激指标水平和良反应发生情况。采用t检验和χ²检验进行统计学分析。结果　试验组丙泊酚、瑞芬太尼、顺式阿曲库铵用量均低于对照组，差异均有统计学意义（均P<0.05）；试验组和对照组术后首次补充镇痛时间分别为（11.39±1.70）h、（4.98±1.12）h，差异有统计学意义（P<0.05）。试验组VAS评分均低于对照组，BCS评分均高于对照组，炎症因子和应激指标水平均低于对照组，差异均有统计学意义（均P<0.05）。试验组不良反应发生率低于对照组［5.77%（3/52）比23.08%（12/52），P<0.05］。结论　胃癌根治术中应用超声引导下TAP神经阻滞有助于降低患者术后疼痛，减轻应激反应和炎症水平，且不会增加不良反应的发生。

关键词: 胃癌根治术, 腹横肌平面神经阻滞, 应激反应, 术后疼痛

Abstract:

Objective　To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) nerve block in radical gastrectomy for gastric cancer. Methods　A total of 104 patients who underwent radical gastrectomy for gastric cancer at Xidian Group Hospital from January 2021 to October 2023 were selected for the randomized control trial, and were divided into a control group and an experimental group by the randomized controlled trial, with 52 cases in each group. There were 29 males and 23 females in the control group; they were (50.81±5.75) years old; their body weight was (61.05±7.53) kg; their body mass index was (23.82±3.14) kg·m^-2; their operation time was (124.35±10.71) min. There were 27 males and 25 females in the experimental group; they were (50.56±5.49) years old; their body weight was (61.44±7.70) kg; their body mass index was (23.63±3.21) kg·m^-2; their operation time was (124.12±10.35) min. The experimental group took ultrasound-guided TAP nerve block and general anesthesia, and the control group general anesthesia. The intraoperative anesthetic drug consumption, perioperative indicators (postoperative recovery time, time to ambulation, and first postoperative analgesic supplementation time), scores of Visual Analog Scale (VAS) and Bruggrmann Comfort Score (BCS) 1, 4, and 8 h after the operation, levels of inflammatory factors and stress indicators before and 24 h after the operation, and incidences of adverse reactions were compared between the two groups by t and χ² tests. Results　The dosages of propofol, remifentanil, and cisatracurium in the experimental group were lower than those in the control group, with statistical differences (all P<0.05). The times for the first postoperative analgesic supplementation in the experimental group and the control group were (11.39±1.70) h and (4.98±1.12) h, respectively, with a statistical difference (P<0.05). The scores of VAS and the levels of inflammatory markers and stress indicators in the experimental group were lower than those in the control group, and the scores of BCS were higher, with statistical differences (all P<0.05). The incidence rate of adverse reactions in the experimental group was lower than that in the control group [5.77% (3/52) vs. 23.08% (12/52); P<0.05]. Conclusion　The application of ultrasound-guided TAP nerve block in radical gastrectomy for patients with gastric cancer helps reduce their postoperative pain, alleviate stress response and inflammation, and does not increase the incidence of adverse reactions.

Key words: Radical gastrectomy, , Transversus abdominis plane nerve block, , Stress response, , Postoperative pain

陈洋刘晓玮龚建平. 超声引导下TAP神经阻滞在胃癌根治术中的应用 [J]. 国际医药卫生导报, 2025, 31(12): 1993-1997.

Chen Yang, Liu Xiaowei, Gong Jianping.

Application of ultrasound-guided TAP nerve block in radical gastrectomy for gastric cancer [J]. International Medicine and Health Guidance News, 2025, 31(12): 1993-1997.

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