曾德敏　贾立勇　阚明威

【摘要】 目的：研究嗎啡联合布比卡因应用于超声下腹横肌平面阻滞（TAP）下腹部肿瘤手术术后镇痛中的效果。方法：选取本院2016年6月-2018年6月在本院接受下腹部肿瘤手术的96例患者纳入研究，将入选患者均分为对照组与观察组，对照组采取术后静脉自控镇痛（PCIA），观察组采取超声引导下腹横肌平面阻滞（TAP）镇痛;观察两组患者术后4、8、16、24 h时动态镇痛效果与静态镇痛效果，观察两组患者术前1 d、术后24 h抗炎因子[白细胞介素-2（IL-2）、γ-干扰素（INF-γ）、白细胞介素-10（IL-10）]表达水平的变化情况，统计两组患者术后镇痛期间不良反应发生情况。结果：观察组各时间点静态VAS评分、动态VAS评分与静态多点VAS评分、动态多点VAS评分整体趋势均低于对照组（P<0.05）;两组术前1 d、术后24 h血清抗炎因子表达水平，组间、组内对比差异均无统计学意义（P>0.05）;观察组不良反应发生率为4.17%，对照组为39.58%，观察组不良反应发生率低于对照组（P<0.05）。结论：吗啡联合布比卡因超声引导下腹横肌平面阻滞，应用于下腹部肿瘤手术术后镇痛中效果更加理想稳定，且不会诱导肿瘤免疫抑制，不良反应较小安全性高。

【关键词】 术后镇痛; 超声引导下腹横肌平面阻滞; 静脉自控镇痛; 吗啡; 布比卡因

Effect of Morphine Combined with Bupivacaine on Postoperative Analgesia in Patients Undergoing Ultrasound-guided Transverse Abdominal Planar Block for Subventral Tumor/ZENG Demin，JIA Liyong，KAN Mingwei.//Medical Innovation of China，2019，16（06）：013-017

【Abstract】 Objective：To study the effect of Morphine combined with Bupivacaine in the postoperative analgesia of ultrasound-guided transverse abdominal planar block for subventral tumor.Method：A total of 96 patients who received lower abdominal tumor surgery in our hospital between June 2016 and June 2018 were included in the study，they were divided into the control group and the observation group.The control group received PCIA，and the observation group received ultrasound-guided transverse abdominal planar block（TAP）for analgesia.Dynamic analgesic effect and static analgesic effect were observed at 4，8，16 and 24 h after surgery in two groups，and anti-inflammatory factors[interleukin-2（IL-2），interferon-γ（INF-γ）and interleukin-10（IL-10）]in two groups were observed at 1 d before and 24 h after surgery，the occurrence of adverse reactions during postoperative analgesia in two groups was statistically analyzed.Result：The overall trend of static VAS score，dynamic VAS score，static multipoint VAS score and dynamic multipoint VAS score of the observation group at each time point were lower than those of the control group（P<0.05）.There were no statistically significant difference in anti-inflammatory factors between two groups at 1 d before and and 24 h after surgery（P>0.05）.The incidence rate of adverse reactions in the observation group was 4.17%，it was lower than 39.58% in the control group（P<0.05）.Conclusion：Morphine combined with Bupivacaine ultrasound can lead to lower transverse abdominal muscle plane block，which is more ideal and stable in the postoperative analgesia of lower abdominal tumor without inducing tumor immunosuppression and with low adverse reactions and high safety.

【Key words】 Postoperative analgesia; Ultrasound-guided transverse abdominal planar block; Intravenous analgesia; Morphine; Bupivacaine

First-authors address：The Fifth Affiliated Hospital of Zunyi Medical College，Zhuhai，Zhuhai 519100，China

doi：10.3969/j.issn.1674-4985.2019.06.004

随着我国外科手术技术水平的不断提高，下腹部肿瘤发生率的上升，致使下腹部肿瘤手术治疗率呈现出上升趋势。术后镇痛是下腹部肿瘤手术治疗的重要环节，患者在术后随着术中麻醉药效逐渐消失，术后疼痛感逐渐显著。严重的术后疼痛可导致血压升高等相关并发症的发生率明显上升，甚至可能影响患者的手术疗效与术后恢复[1-3]。因此术后镇痛对于下腹部肿瘤手术患者的康复具有重要意义。术后静脉自控镇痛是近年来临床上较为常用的术后镇痛方式，但易发生过度镇痛、不良反应较多等问题。……