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。
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．
