标题：超声引导下罗哌卡因腹横肌平面阻滞对胃癌患者术后疼痛及认知功能的影响

      作者：翟春丽，唐小娜，王丙礼    葫芦岛市第二人民医院麻醉科，辽宁 葫芦岛 125001

      卷次： 2020年31卷12期

      【摘要】 目的 探究超声引导下罗哌卡因腹横肌平面阻滞对胃癌患者术后疼痛及认知功能的影响。方法 选取2018年1月至2019年1月在葫芦岛市第二人民医院行胃癌根治术患者82例，采用随机数表法分为对照组和观察组各41例。对照组患者术后采取静脉自控镇痛泵缓解疼痛，观察组患者在对照组基础上采用超声引导下罗哌卡因腹横肌平面阻滞镇痛。比较两组患者术后疼痛(VAS)评分及镇静(Ramsay)评分、术前术后认知功能(MMSE)评分、术后首次使用镇痛药时间和术后48 h舒芬太尼使用总量，以及两组患者治疗期间的不良反应情况。结果 术后2 h、6 h、12 h、24 h、48 h，观察组患者的VAS评分明显低于对照组，Ramsay镇静评分明显高于对照组，差异均有统计学意义(P<0.05)；术后 3 d、7 d，观察组患者的MMSE评分分别为(26.68±0.54)分、(28.02±0.67)分，明显高于对照组的(25.11±0.73)分、(27.23±0.88)分，差异均有统计学意义(P<0.05)，但术后7 d，两组患者的MMSE评分与术前比较差异均无统计学意义(P>0.05)；观察组患者术后首次使用镇痛药时间为(438.17±56.13) min，明显长于对照组的(391.24±54.36) min，舒芬太尼使用总量为(74.21±2.42) μg，明显少于对照组的(97.34±4.15) μg，差异均有统计学意义(P<0.05)；治疗期间，观察组患者的不良反应率为9.76%，明显低于对照组的26.83%，差异有统计学意义(P<0.05)。结论 超声引导下罗哌卡因腹横肌平面阻滞能减轻胃癌患者术后疼痛，对患者术后认知功能影响较小，且具有一定安全性。
      【关键词】 超声引导；腹横肌平面阻滞；罗哌卡因；胃癌；术后疼痛；认知功能
      【中图分类号】 R735.2 【文献标识码】 A 【文章编号】 1003—6350（2020）12—1504—03

Effects of ultrasound-guided ropivacaine transversus abdominis plane block on postoperative pain and cognitivefunction of gastric cancer patients.
ZHAI Chun-li, TANG Xiao-na, WANG Bing-li. Department of Anesthesiology,Huludao Second People's Hospital, Huludao 125001, Liaoning, CHINA
【Abstract】 Objective To explore the effects of ultrasound-guided ropivacaine transversus abdominis planeblock (TAPB) on postoperative pain and cognitive function of gastric cancer patients. Methods During the period fromJanuary 2018 to January 2019, 82 patients who underwent radical surgery of gastric cancer in Huludao Second People'sHospital were divided into control group and observation group by random number table method, with 41 patients in eachgroup. After surgery, the control group was given patient-controlled intravenous analgesia (PCIA) pump to relieve pain.On this basis, the observation group was given ultrasound-guided ropivacaine TAPB for analgesia. The scores of postopera-tive pain (Visual Analogue Scale, VAS) score, sedation (Ramsay) score, scores of Mini-mental State Examination (MMSE)before and after surgery, postoperative first usage time of analgesics, total usage amount of sufentanil at 48 h after surgery,and adverse reactions during treatment were compared between the two groups. Results After 2 h, 6 h, 12 h, 24 h and48 h of surgery, VAS scores in observation group were significantly lower than those in control group, while Ramsay se-dation scores were significantly higher than those in control group (P<0.05). At 3 d and 7 d after surgery, MMSE scoresin the observation group were (26.68±0.54) points and (28.02±0.67) points, significantly higher than (25.11±0.73) pointsand (27.23±0.88) points in the control group (P<0.05). At 7 d after surgery, differences in MMSE scores of both groupswere not statistically significant from those before surgery (P>0.05). The postoperative first usage time of analgesics inobservation group was (438.17±56.13) min, significantly longer than (391.24±54.36) min in control group, while total us-age amount of sufentanil was (74.21±2.42) μg, significantly less than (97.34±4.15) μg in the control group (P<0.05).During treatment, adverse reaction rate in observation group was 9.76%, significantly lower than 26.83% in the controlgroup (P<0.05). Conclusion Ultrasound-guided ropivacaine TAPB can relieve postoperative pain of gastric cancer pa-tients, with fewer effects on their postoperative cognitive function and certain safety.
      【Key words】 Ultrasound-guided; Transversus abdominis plane block; Ropivacain; Gastric cancer; Postoperativepain; Cognitive function