2021 年第 6 期 第 16 卷

不同浓度罗哌卡因腹横肌平面阻滞在肥胖患者上腹部手术中的镇痛效果和安全性

Analgesic effect and safety of different concentrations of ropivacaine for transabdominal transverse plane nerve block on obese patients undergoing upper abdominal surgery

作者：龚友明1吕瑶2张婵2姚猛飞2万红1

英文作者：Gong Youming1 Lyu Yao2 Zhang Chan2 Yao Mengfei2 Wan Hong1

单位：1中国人民解放军联勤保障部队第九〇九医院消化内镜中心，福建省漳州市363000；2中国人民解放军联勤保障部队第九〇九医院麻醉科，福建省漳州市363000

英文单位：1Digestive Endoscopy Center the 909th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army Fujian Province Zhangzhou 363000 China; 2Department of Anesthesiology the 909th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army Fujian Province Zhangzhou 363000 China

关键词：腹横肌平面阻滞；罗哌卡因；肥胖；镇痛效果；安全性

英文关键词：Transabdominaltransverseplanenerveblock;Ropivacaine;Obesity;Analgesiceffect;Safety

• 摘要：

• 目的 探讨不同浓度罗哌卡因腹横肌平面阻滞在肥胖患者上腹部手术中的镇痛效果和安全性。方法 选取中国人民解放军联勤保障部队第九〇九医院2017年1月1日至2019年12月1日收治的120例行上腹部手术的肥胖患者。术前均予超声引导下腹横肌平面罗哌卡因神经阻滞，完全随机分为A组（罗哌卡因浓度为0.2%）、B组（罗哌卡因浓度为0.375%）、C组（罗哌卡因浓度为0.5%），各40例。对比3组患者阻滞起效时间、阻滞持续时间、腹壁肌肉松弛程度、阻滞范围以及术后第1、6、12、24、48小时疼痛视觉模拟量表（VAS）评分和伯格曼舒适度量表（BCS）评分、不良反应发生率等指标。结果 C组阻滞起效时间短于A组和B组，B组和C组阻滞持续时间、腹直肌厚度差值长于/大于A组，B组和C组T6和T11神经节段阻滞有效率高于A组（均P<0.05）。B组和C组术后12、24 h VAS评分低于A组，BCS评分高于A组［VAS评分：（2.52±0.93）、（2.52±0.87）分比（3.67±1.42）分，（2.92±0.65）、（3.10±1.10）分比（3.52±1.19）分；BCS评分：（2.5±1.1）、（2.4±0.9）分比（1.9±1.0）分，（2.2±1.0）、（2.3±1.0）分比（1.6±0.7）分］，差异均有统计学意义（均P<0.05）。C组头晕头痛、恶心呕吐、穿刺点瘙痒发生率高于A组和B组（均P<0.05）；3组均无脏器损伤发生。结论 在行上腹部手术的肥胖患者中予罗哌卡因腹横肌平面阻滞是安全、有效的镇痛方案，浓度越高镇痛效果越好，但是不良反应发生率越高。

• Objective To investigate the analgesic effect and safety of different concentrations of ropivacaine for transabdominal transverse plane nerve block on obese patients undergoing upper abdominal surgery. Methods From January 1st, 2017 to December 1st, 2019, 120 patients undergoing upper abdominal surgery in the 909th Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army were enrolled. All patients were preoperatively treated with ultrasound-guided ropivacaine nerve block in the transverse plane of the lower abdomen. They were randomly divided into group A(with ropivacaine concentration of 0.2%), group B(with ropivacaine concentration of 0.375%), and group C(with ropivacaine concentration of 0.5%), with 40 cases in each group. The onset time of block, duration of block, degree of abdominal wall muscle relaxation, block range, and scores of pain visual analogue scale(VAS) and Bruggrmann comfort scale(BCS) at 1, 6, 12, 24, 48 h after operation, as well as incidence of adverse reactions were compared among the three groups. Results The onset time of block in group C was shorter than that in group A and group B, duration of block and difference of rectus abdominis thickness in group B and group C were longer/greater than those in group A, the effective rates of T6 and T11 ganglion block in group B and group C were higher than those in group A(all P<0.05). At 12 and 24 h after operation, the VAS scores in group B and group C were lower than those in group A, and the BCS scores in group B and group C were higher than those in group A［VAS scores:（2.52±0.93）,（2.52±0.87）vs （3.67±1.42）;（2.92±0.65）,（3.10±1.10）vs （3.52±1.19）; BCS scores:（2.5±1.1）,（2.4±0.9）vs （1.9±1.0）;（2.2±1.0）,（2.3±1.0）vs （1.6±0.7）］(all P<0.05). The incidences of dizziness and headache, nausea and vomiting, pruritus at puncture point in group C were higher than those in group A and group B, and the differences were statistically significant(all P<0.05). No organ injury occurred in the three groups. Conclusions  In obese patients undergoing upper abdominal surgery, ropivacaine via transverse abdominal nerve block is a safe and effective analgesic program. The higher the concentration, the better the analgesic effect is, but the higher the incidence of adverse reactions is.