超声引导下的双侧TAP阻滞对上腹部手术患者血流动力学、炎症反应及术后镇痛的影响

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Abstract Objective To investigate the effect of ultrasound-guided bilateral transverse abdominalmuscle (TAP) block on hemodynamics, inflammatory response and postoperative analgesia in patients undergoing upper abdominal surgery. Methods Sixty patients who underwent upper abdominal surgery admitted to Nanjing Gaochun People’s Hospital of Nanjing from September 2017 to October 2019 were selected. They were divided into observation group and control group by random number table method, with 30 cases in each group. Under general anesthesia, the observation group was injected with 0.25% Ropivacaine 20 mL bilateral in TAP under the guidance of ultrasound, while the control group was injected with the same amount of normal saline. Upper abdominal surgery was performed in both groups 30 min after injection. Clinical indicators were compared between the two groups. The hemodynamic indexes of the two groups were compared at each time point during the surgery. Resting and moving visual analogue scores (VAS) before surgery and 4, 12, 24 h after surgery were compared between the two groups. The levels of inflammatory factors before surgery and 1, 3 d after surgery were compared between the two groups. The incidence of adverse reactions was compared between the two groups. Results The changes of blood pressure and heart rate (HR) in the observation group were lower than those in the control group, and the postoperative exhaust time and the time to first get ont of bed in the observation group were shorter than those in the control group, with statistical significance (all P ＜ 0.05). HR and mean arterial pressure (MAP) at T1 and T2 were lower than T0 in the two groups, and HR at T2 was lower than T1 and MAP was higher than T1 in the two groups. HR at T1 and T2 in the observation group was lower than the control group at the same time point, and MAP was higher than the control group at the same time points, with statistical significance (all P ＜ 0.05). The resting and moving VAS 12, 24 h after surgery in both groups were lower than 4 h after surgery, and 24 h after surgery was lower than 12 h after surgery. The resting and moving VAS of the observation group at 12, 24 h after surgery were lower than those of the control group at the same time points, and the differences were statistically significant (all P ＜ 0.05). The levels of interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in both groups at 1, 3 d after surgery were higher than those before surgery, and the levels of IL-6, CRP and TNF-α in three days after surgery were lower than those on one day after surgery. The levels of IL-6, CRP and TNF-α in observation group at 1, 3 d after surgery were higher than those in control group at the same time points, and the differences were statistically significant (all P ＜ 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P ＞ 0.05). Conclusion Ultrasound guided bilateral TAP block can effectively meet the postoperative analgesia needs of upper abdominal patients, reduce the pain of patients, change hemodynamics, and reduce the release of inflammatory factors, which is relatively safe and reliable.

Key words： Ultrasound Transverse abdominal muscle block Upper abdominal surgery Hemodynamics Inflammatory response Postoperative analgesia

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	WANG Wenjuan1 WU Xiangrong1 HUANG Changyun2

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WANG Wenjuan1 WU Xiangrong1 HUANG Changyun2. Effects of ultrasound-guided bilateral TAP block on hemodynamics, inflammatory response and postoperative analgesia in patients undergoing upper abdominal surgery[J]. 中国医药导报, 2021, 18(16): 104-108.

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https://www.yiyaodaobao.com.cn/EN/ OR https://www.yiyaodaobao.com.cn/EN/Y2021/V18/I16/104

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