Anesthesiology and Pain Management
Anesthesiology and Pain Management. 2025; 1: (1) ; 10.12208/j.apm.20250002 .
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陕西省人民医院麻醉科 陕西西安
*通讯作者： Zhao Xu,单位：陕西省人民医院麻醉科 陕西西安；
目的 研究分析腹横肌平面阻滞的疗效（TAPB）和患者自控静脉镇痛。方法 选取2020年10月至2023年5月于我院接受择期腹腔镜手术的老年患者100例，按随机数字表法分为研究组与对照组，每组50例。两组患者术中均给予全身麻醉，对照组患者接受PCIA干预，研究组患者术后接受横向肌平面阻滞联合自控静脉镇痛。评估并比较两组患者术后疼痛及躁动情况、围手术期不同阶段认知功能以及术后早期康复情况。结果 研究组患者术后12h、36hVAS评分低于对照组，躁动发生率低于对照组，差异有统计学意义（P<0.05）。术前24小时两组MMSE评分比较差异无统计学意义（P<0.05），术后24小时、72小时研究组MMSE评分均高于对照组，差异均有统计学意义（P<0.05）。研究组患者首次进食时间、下床时间、排气时间、排便时间及围手术期住院时间均短于对照组，差异有统计学意义（P<0.05）。结论 老年患者腹腔镜手术联合应用TAPB与PCIA可增强术后镇痛效果，减少躁动发生率，改善术后早期认知功能，促进早期康复。
Objective To study and analyze the effects of transversus abdominis plane block (TAPB) and patient controlled intravenous analgesia (PCIA) on cognitive function and early rehabilitation in elderly patients undergoing laparoscopic surgery. Methods 100 elderly patients undergoing elective laparoscopic surgery in our hospital from October 2020 to May 2023 were selected and divided into study group and control group by random number table method, with 50 cases in each group. Patients in both groups were given general anesthesia during the operation, patients in the control group received PCIA intervention, and patients in the study group received postoperative transversal muscle plane block combined with controlled intravenous analgesia. Postoperative pain and agitation, perioperative cognitive function at different stages, and early postoperative rehabilitation were evaluated and compared between the two groups. Results VAS scores in the study group were lower than those in the control group at 12h and 36h after surgery, and the incidence of agitation was lower than that in the control group, with statistical differences (P < 0.05). There was no statistical difference in MMSE scores between the two groups 24 hours before surgery (P < 0.05), and the MMSE scores in the study group were higher than those in the control group 24 hours and 72 hours after surgery, with statistical significance (P < 0.05). The time of first feeding, leaving bed, exhaust gas, defecation and perioperative hospital stay in the study group were shorter than those in the control group, and the differences were statistically significant (P < 0.05). Conclusion The combined application of TAPB and PCIA in elderly patients undergoing laparoscopic surgery can enhance the postoperative analgesia effect, reduce the incidence of agitation, improve early postoperative cognitive function, and promote early rehabilitation.
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