超声引导下腹横肌平面阻滞联合无阿片药全麻在腹腔镜子宫全切术中的应用

doi:10.20223/j.cnki.1000-8535.2025.11.018

摘要/Abstract

摘要： 目的探讨超声引导下腹横肌平面阻滞（TAP）联合无阿片药全身麻醉（全麻）在腹腔镜子宫全切术中的应用效果。方法选取武威市凉州医院2021年5月—2023年5月收治的60例择期行腹腔镜子宫全切术患者展开前瞻性研究,应用抽签法将其分为观察组与对照组,各30例。对照组患者实施常规阿片类药物全麻,观察组采用TAP联合无阿片药全身麻醉。对比两组患者入室后（T0）、切皮时（T1）、手术10 min后（T2）和手术结束即刻（T3）生命体征变化,麻醉后监测治疗室（PACU）恢复情况,术后1、4、8、12、24、48 h疼痛程度,最后对比其48 h内不良反应发生率。结果两组T0、T1、T2、T3时间血氧饱和度（SpO2）,T0、T3时间平均动脉压（MAP）、心率水平无明显变化,两组对比差异无统计学意义（P>0.05）,T1、T2时间对照组MAP、心率升高,观察组T1、T2的MAP、心率均低于对照组（P<0.05）;观察组PACU停留时间、首次肛门排气时间明显低于对照组（P<0.05）;观察组术后1、4、8、12、24、48 h活动时视觉模拟量表（VAS）评分与静息时VAS评分低于对照组（P<0.05）;观察组术后48 h内不良反应发生率比对照组更低（P<0.05）。结论针对腹腔镜子宫全切术患者采取超声引导下TAP联合无阿片药全麻可稳定患者术中生命体征,缩短患者术后恢复时间,减轻疼痛程度,且可降低术后48 h内不良反应发生率。

关键词: 阿片类药物, 腹腔镜子宫全切术, 腹横肌平面阻滞, 生命体征, 术后镇痛, 不良反应

Abstract: Objective To explore the application effect of ultrasound-guided transverse abdominis plane（TAP）block combined with opioid-free general anesthesia in laparoscopic total hysterectomy．Methods A prospective study was conducted in 60 patients who underwent selective laparoscopic total hysterectomy in Wuwei Liangzhou Hospital from May 2021 to May 2023．They were divided into a observation group and a control group using a lottery method,30 cases in each group．The control group received routine opioid general anaesthesia,while the observation group received TAP in combination with opioid-free general anaesthesia．Comparing the changes of vital signs after invasion（T0）,skin cutting（T1）,10 min after operating（T2）,the end of surgery（T3）,and condition in the post-anesthesia care unit（PACU）after anesthesia,the pain degree at 1 h,4 h,8 h,12 h,24 h and 48 h after surgery,and the incidence of adverse reactions within 48 h．Results There were no significant changes in blood SpO2,mean arterial pressure（MAP）and heart rate at T0,T1,T2 and T3 in both groups,and no significant difference between the two groups（P>0.05）．MAP and heart rate increased in the control group at T1 and T2,while those in the observation group were lower than the control group（P<0.05）．The observation group had significantly shorter PACU time and first anal exhaust time than the control group（P<0.05）．VAS scores at 1 h,4 h,8 h,12 h,24 h and 48 h after surgery and VAS score at rest in the observation group were lower than in the control group（P<0.05）．The incidence of adverse reactions within 48 h after surgery was lower in the observation group than in the control group（P<0.05）．Conclusions Ultrasound guided TAP combined with opioid-free general anesthesia can stabilize intraoperative vital signs,shorten postoperative recovery time,alleviate postoperative pain,and reduce the incidence of anesthesia related adverse reactions within 48 hours for patients undergoing laparoscopic total hysterectomy．

Key words: opioid drugs, laparoscopic total hysterectomy, transverse abdominis plane block, vital signs, postoperative analgesia, adverse reactions

肖斌, 陈春霞, 孙有平, 谢金玲, 刘余钱. 超声引导下腹横肌平面阻滞联合无阿片药全麻在腹腔镜子宫全切术中的应用[J]. 广州医药, 2025, 56(11): 1593-1598.

XIAO Bin, CHEN Chunxia, SUN Youping, XIE Jinling, LIU Yuqian. Application of ultrasound-guided transverse abdominis plane block combined with opioid-free general anesthesia in laparoscopic total hysterectomy[J]. Guangzhou Medical Journal, 2025, 56(11): 1593-1598.

参考文献

[1] PICKETT C M,SEERATAN D D,MOL B W J,et al.Surgical approach to hysterectomy for benign gynaecological disease[J].Cochrane Database Syst Rev,2023,8(8):CD003677.
[2] ABDEL KHALEK Y,BITAR R,CHRISTOFOROU C,et al.Uterine manipulator in total laparoscopic hysterectomy:Safety and usefulness[J].Updates Surg,2020,72(4):1247-1254.
[3] AZADI A,MASOUD A T,ULIBARRI H,et al.Vaginal hysterectomy compared with laparoscopic hysterectomy in benign gynecologic conditions:A systematic review and meta-analysis[J].Obstet Gynecol,2023,142(6):1373-1394.
[4] 廖春英,王云,李慧利,等.超声引导下外侧弓状韧带上腰方肌前路阻滞与腹横肌平面阻滞在子宫切除术中的比较[J].临床麻醉学杂志,2022,38(7):716-720.
[5] 刘民强,吴强,洪凤珠,等.无阿片保留自主呼吸麻醉技术在胸科日间手术中的应用现状[J].广东医学,2022,43(1):127-130.
[6] 徐惠成,梁志清.子宫颈癌腹腔镜手术操作指南[J].中国癌症防治杂志,2012,4(1):23-28.
[7] 吕晨,邹建玲,沈淑华,等.视觉模拟量表和语言评价量表用于术后疼痛评估的比较[J].全科医学临床与教育,2004,2(4):214-215,219.
[8] 袁静静,陈书涵,谢艳乐,等.亚麻醉剂量艾司氯胺酮对胸腔镜手术后阿片类药物镇痛消耗量的影响[J].中华医学杂志,2022,102(15):1108-1113.
[9] 李军,章钰.阿片类药物的镇静作用[J].医学研究杂志,2023,52(5):1-4.
[10] 陈瑜,玉红,李程玉,等.加速康复外科理念下标准化多模式镇痛对上腹部大手术术后阿片类药物使用量的影响[J].中国普外基础与临床杂志,2022,29(4):475-480.
[11] 余莲雅,张静,郑蓓,等.外侧弓状韧带上腰方肌前侧阻滞与腹横肌平面阻滞在腹腔镜下全子宫切除术术后恢复质量的比较[J].医学研究杂志,2023,52(8):140-143.
[12] 金成浩,赵美一,阴阅,等.不同剂量瑞芬太尼复合小剂量艾司氯胺酮用于腹腔镜妇科手术患者的效果及对麻醉效能、疼痛的影响[J].现代生物医学进展,2024,24(1):65-69.
[13] 胡松权,宋劼,周群.超声引导腹横肌平面阻滞联合腹直肌鞘阻滞在腹腔镜全子宫切除术患者中的应激状况及术后镇痛效果[J].中国妇幼保健,2022,37(6):1140-1143.
[14] MARCHAND G,TAHER MASOUD A,ABDELSATTAR A,et al.Systematic review and meta-analysis of laparoscopic radical hysterectomy vs.robotic assisted radical hysterectomy for early stage cervical cancer[J].Eur J Obstet Gynecol Reprod Biol,2023(289):190-202.
[15] 钱夏丽,陈雅洁,冯善武,等.右美托咪定、艾司氯胺酮和利多卡因复合用药行无阿片类药物用于乳腺肿块切除术麻醉的可行性[J].江苏医药,2022,48(2):154-157.
[16] 刘天琳,托景堂,魏倩杰,等.腹腔镜全子宫切除术丙泊酚联合艾司氯胺酮麻醉诱导对患者术后早期认知功能的影响[J].中国计划生育学杂志,2022,30(10):2258-2261.
[17] 李静,王伟,石军.瑞芬太尼、丙泊酚复合异氟醚麻醉对腹腔镜全子宫切除术患者炎性因子及血流动力学的影响[J].川北医学院学报,2023,38(8):1074-1077.
[18] 蒋迅,江涛.乌司他丁联合不同剂量右美托咪定对妇科腹腔镜子宫切除术患者血流动力学及血清NSE S100β水平的影响[J].中国妇幼保健,2022,37(23):4331-4335.
[19] 刘海艳,魏雪琴.右美托咪定与咪达唑仑在儿童牙科患者术前镇静中的临床应用[J].广州医药,2022,53(2):108-111,115.
[20] 马良超,张佳,李伟,等.腹腔镜子宫切除术前与术后行腹横肌平面阻滞对患者术后镇痛及恢复进度的影响[J].临床与病理杂志,2023,43(3):529-535.
[21] 王艺丹,郭其发,沈通桃.竖脊肌平面阻滞联合无阿片药全身麻醉在乳腺癌手术中的临床效果[J].实用临床医药杂志,2023,27(6):101-105.
[22] 薛玉荣,张景超,张祥飞.依托咪酯联合TAPB麻醉对经腹全子宫切除术患者血清相关因子及免疫功能的影响[J].中华内分泌外科杂志,2023,17(6):706-710.
[23] MOESCHLER S M,POLLARD E M,PINGREE M J,et al.Ultra sound-guided transversus abdominis plane block vs.trig ger point injections for chronic abdominal wall pain:A randomized clinical trial[J].Pain,2021,162(6):1800-1805.
[24] 陈吉鹏,侯景丽.超声引导下腹横肌平面阻滞联合全身麻醉在腹腔镜子宫切除术中的应用效果[J].检验医学与临床,2022,19(8):1022-1025.
[25] 王君灵,蔡弥松,张作锋.腹横筋膜平面阻滞与腹横肌平面阻滞对腹腔镜子宫切除术患者术后镇痛及早期康复的影响[J].临床与病理杂志,2022,42(12):2983-2989.