超声引导下腹横肌平面阻滞在急性胰腺炎中的应用及对腹痛、PAP水平的影响

doi:10.3969/j.issn.1004-583X.2024.04.007

摘要/Abstract

摘要：

目的探讨超声引导下腹横肌平面(Transversus abdominis plane, TAP)阻滞在急性胰腺炎中的应用及对腹痛、胰腺炎相关蛋白(Pancreatitis-associated protein,PAP)水平的影响。方法选取2019年7月-2023年8月我院收治的急性胰腺炎患者95例,按照随机数表法分成2组,即对照组47例,试验组 48例。对照组给予静脉注入舒芬太尼镇痛,试验组给予超声引导下TAP阻滞镇痛。比较两组镇痛后生命体征、腹痛发生率、PAP阳性率、疼痛、镇静评分、淀粉酶、脂肪酶、尿淀粉酶、系统急性生理学及慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)、改良多脏器功能障碍(multiple organ dysfunction score,Marshall)评分变化情况。结果两组镇痛后体温比较差异无统计学意义(P>0.05);试验组心率、呼吸频率低于对照组,氧合指数高于对照组(P<0.05);镇痛后,试验组腹痛发生率及PAP阳性率低于对照组(P<0.05);镇痛后,两组疼痛、镇静评分均降低,且试验组降低更显著(P<0.05);镇痛后,两组淀粉酶、脂肪酶及尿淀粉酶均降低,且试验组降低更显著(P<0.05);镇痛后,两组APACHEⅡ、Marshall评分均降低,且试验组降低更显著(P<0.05)。结论超声引导下TAP阻滞在急性胰腺炎镇痛中有一定的效果,可有效改善患者腹痛、PAP水平。

关键词: 胰腺炎, 腹痛, 超声引导下, 腹横肌平面阻滞, 胰腺炎相关蛋白质类

Abstract:

Objective To study application of ultrasound-guided transverse abdominal plane (TAP) block in acute pancreatitis and its effect on abdominal pain and pancreatitis associated protein (PAP) level. Methods Ninety-five patients with acute pancreatitis admitted to our hospital from July 2019 to August 2023 were enrolled in this study. They were randomly assigned into the control group (n=47, intravenous injection of sufentanil for analgesia) and the experimental group (n=48, ultrasound-guided TAP block for analgesia). The changes in vital signs, incidence of abdominal pain, positive rate of PAP, pain, sedation score, amylase, lipase, urine amylase, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) and Modified Multiple Organ Dysfunction Score (modified Marshall score) were compared between the two groups after analgesia. Results There was no significant difference in body temperature between the two groups after analgesia (P>0.05). The heart rate and respiratory rate in the experimental group were significantly lower than those of control group, but the oxygenation index was significantly higher (P<0.05). After analgesia, the incidence of abdominal pain and positive rate of PAP in experimental group were significantly lower than those of control group (P<0.05). After analgesia, pain and sedation scores were significantly decreased in both groups, and the reductions in experimental group were more obvious relative to the control group (P<0.05). After analgesia, amylase, lipase and urine amylase were significantly decreased in both groups, and the decreases in experimental group were more common compared to the control group (P<0.05). After analgesia, the APACHEⅡ and Marshall scores of both groups were significantly decreased, and the decreases in the experimental group were more pronounced compared with the control group (P<0.05). Conclusion Ultrasound-guided TAP block has a certain effect in the analgesia of acute pancreatitis, which can effectively improve the abdominal pain and PAP level of patients.

Key words: pancreatitis, abdominal pain, under ultrasonic guidance, plane block of transverse abdominal muscle, pancreatitis-associated proteins

中图分类号:

R576

张圆, 马亮, 黄涛, 王海丽. 超声引导下腹横肌平面阻滞在急性胰腺炎中的应用及对腹痛、PAP水平的影响[J]. 临床荟萃, 2024, 39(4): 337-341.

Zhang Yuan, Ma Liang, Huang Tao, Wang Haili. Application of ultrasound-guided TAP block in acute pancreatitis and its effect on abdominal pain and PAP level[J]. Clinical Focus, 2024, 39(4): 337-341.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.04.007

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I4/337

图/表 5

表1 两组镇痛后生命体征比较($\bar{x}±s$)

Tab.1 Comparison of vital signs after analgesia between groups

组别	例数	心率 (次/min)	体温 (℃)	呼吸频率 (次/min)	氧合指数 (mmHg)
试验组	48	99.14±10.14	37.21±0.41	20.04±3.12	295.24±27.56
对照组	47	113.24±13.25	37.18±0.50	24.41±5.12	247.47±45.26
$t$ 值		5.832	0.320	5.035	6.228
$P$ 值		0.000	0.749	0.000	0.000

表1 两组镇痛后生命体征比较($\bar{x}±s$)

Tab.1 Comparison of vital signs after analgesia between groups

组别	例数	心率 (次/min)	体温 (℃)	呼吸频率 (次/min)	氧合指数 (mmHg)
试验组	48	99.14±10.14	37.21±0.41	20.04±3.12	295.24±27.56
对照组	47	113.24±13.25	37.18±0.50	24.41±5.12	247.47±45.26
$t$ 值		5.832	0.320	5.035	6.228
$P$ 值		0.000	0.749	0.000	0.000

表2 两组镇痛后腹痛、PAP阳性率比较[例(%)]

Tab.2 Comparison of abdominal pain and PAP positive rate after analgesia between groups

组别	例数	腹痛发生率	PAP阳性率
试验组	48	6(12.5)	2(4.2)
对照组	47	15(31.9)	9(19.2)
χ²值		5.199	5.207
$P$ 值		0.023	0.023

表2 两组镇痛后腹痛、PAP阳性率比较[例(%)]

Tab.2 Comparison of abdominal pain and PAP positive rate after analgesia between groups

组别	例数	腹痛发生率	PAP阳性率
试验组	48	6(12.5)	2(4.2)
对照组	47	15(31.9)	9(19.2)
χ²值		5.199	5.207
$P$ 值		0.023	0.023

表3 两组疼痛、镇静评分比较(分)

Tab.3 Comparison of pain and sedation scores after analgesia between groups

组别	例数	VAS			Ramsay
组别	例数	入院时	镇痛6 h	镇痛12 h	入院时	镇痛6 h	镇痛12 h
试验组	48	7.14±0.35	4.57±0.50^*	2.74±0.61^*	4.58±1.23	3.05±0.94^*	2.61±0.65^*
对照组	47	7.15±0.42	5.68±0.52^*	3.64±0.62^*	4.49±1.18	3.88±1.01^*	3.08±0.78^*
$t$ 值		0.126	10.606	7.132	0.364	4.147	3.193
$P$ 值		0.899	0.000	0.000	0.717	0.000	0.002

表3 两组疼痛、镇静评分比较(分)

Tab.3 Comparison of pain and sedation scores after analgesia between groups

组别	例数	VAS			Ramsay
组别	例数	入院时	镇痛6 h	镇痛12 h	入院时	镇痛6 h	镇痛12 h
试验组	48	7.14±0.35	4.57±0.50^*	2.74±0.61^*	4.58±1.23	3.05±0.94^*	2.61±0.65^*
对照组	47	7.15±0.42	5.68±0.52^*	3.64±0.62^*	4.49±1.18	3.88±1.01^*	3.08±0.78^*
$t$ 值		0.126	10.606	7.132	0.364	4.147	3.193
$P$ 值		0.899	0.000	0.000	0.717	0.000	0.002

表4 两组酶类水平比较(U/L)

Tab.4 Comparison of enzyme levels after analgesia between groups

组别	例数	淀粉酶		脂肪酶		尿淀粉酶
组别	例数	镇痛前	镇痛后	镇痛前	镇痛后	镇痛前	镇痛后
试验组	48	98.93±7.54	68.26±6.31^*	816.20±72.24	661.23±67.52^*	935.42±83.59	541.05±62.16^*
对照组	47	98.88±7.38	79.88±13.21^*	816.31±72.30	735.56±65.15^*	935.12±83.62	693.52±76.75^*
$t$ 值		0.033	5.489	0.007	5.459	0.017	10.651
$P$ 值		0.974	0.000	0.994	0.000	0.986	0.000

表4 两组酶类水平比较(U/L)

Tab.4 Comparison of enzyme levels after analgesia between groups

组别	例数	淀粉酶		脂肪酶		尿淀粉酶
组别	例数	镇痛前	镇痛后	镇痛前	镇痛后	镇痛前	镇痛后
试验组	48	98.93±7.54	68.26±6.31^*	816.20±72.24	661.23±67.52^*	935.42±83.59	541.05±62.16^*
对照组	47	98.88±7.38	79.88±13.21^*	816.31±72.30	735.56±65.15^*	935.12±83.62	693.52±76.75^*
$t$ 值		0.033	5.489	0.007	5.459	0.017	10.651
$P$ 值		0.974	0.000	0.994	0.000	0.986	0.000

表5 两组临床评分比较(分)

Tab.5 Comparison of clinical scores after analgesia between groups

组别	例数	APACHEⅡ		Marshall评分
组别	例数	镇痛前	镇痛后	镇痛前	镇痛后
试验组	48	13.67±2.14	4.67±1.51^*	4.18±0.34	1.51±0.41^*
对照组	47	13.70±2.08	7.33±1.48^*	4.23±0.26	2.04±0.51^*
$t$ 值		0.069	8.669	0.804	5.588
$P$ 值		0.945	0.000	0.423	0.000

表5 两组临床评分比较(分)

Tab.5 Comparison of clinical scores after analgesia between groups

组别	例数	APACHEⅡ		Marshall评分
组别	例数	镇痛前	镇痛后	镇痛前	镇痛后
试验组	48	13.67±2.14	4.67±1.51^*	4.18±0.34	1.51±0.41^*
对照组	47	13.70±2.08	7.33±1.48^*	4.23±0.26	2.04±0.51^*
$t$ 值		0.069	8.669	0.804	5.588
$P$ 值		0.945	0.000	0.423	0.000

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