Application of ultrasound-guided TAP block in acute pancreatitis and its effect on abdominal pain and PAP level

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

Abstract

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

CLC Number:

R576

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.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.04.007

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

Figures/Tables 5

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

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

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

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

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

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

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

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

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

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

References 25

[1]	邢婷婷, 高俊茶. Presepsin在急性胰腺炎中的研究进展[J]. 临床荟萃, 2022, 37(8):764-768.
[2]	丁伟超, 周京江, 耿润露, 等. 组合式血液净化技术在治疗重症高甘油三酯血症性急性胰腺炎中的临床应用[J]. 中国现代医学杂志, 2023, 33(12):11-17.
[3]	Cridge H, Twedt DC, Marolf AJ, et al. Advances in the diagnosis of acute pancreatitis in dogs[J]. J Vet Intern Med, 2021, 35(6):2572-2587. doi: 10.1111/jvim.16292 pmid: 34751442
[4]	吴昊, 李静. RDW、NLR、D-二聚体联合检测对急性胰腺炎病情的预测价值[J]. 临床荟萃, 2021, 36(6):504-508.
[5]	中国医疗保健国际交流促进会急诊医学分会, 脓毒症预防与阻断联盟, 郭喆, 等. 重症急性胰腺炎预防与阻断急诊专家共识[J]. 中国急救医学, 2022, 42(5):11.
[6]	刘康, 田道. 胸段硬膜外阻滞治疗急性重症胰腺炎疗效及对患者肾功能的影响[J]. 陕西医学杂志, 2022, 51(7):839-842.
[7]	荆治, 李瑛琪, 晁辉. 超声引导下空肠置管术联合中药对急性胰腺炎早期胃肠功能、血清炎性因子及SAS/SDS评分影响[J]. 中华中医药学刊, 2022, 40(6):251-254.
[8]	Iannuzzi JP, King JA, Leong JH, et al. Global incidence of acute pancreatitis is increasing over time: A systematic review and meta-analysis[J]. Gastroenterology, 2022, 162(1):122-134.
[9]	周敏, 苏林娜, 吕海茹. 腹腔穿刺引流对胰腺炎患者胰蛋白酶原激活肽、白介素-6表达的影响[J]. 现代生物医学进展, 2021, 21(9):1660-1663+1632.
[10]	陈立佳, 王敏, 刘雅涵, 等. 生长抑素结合早期肠内营养对重症急性胰腺炎患者炎性调控的临床效果评价[J]. 现代消化及介入诊疗, 2023, 28(4):481-485.
[11]	杜召辉, 邱兆磊, 营巧玲. 帕瑞昔布钠联合地佐辛注射液在重症急性胰腺炎中的应用[J]. 中华全科医学, 2019, 17(11):1825-1828.
[12]	蒋骅, 汪小华, 陶春霞. 急性胰腺炎患者急性期疼痛现状及其对住院时间的影响[J]. 中国全科医学, 2018, 21(27):3366-3369. doi: 10.12114/j.issn.1007-9572.2018.00.038
[13]	范之丹, 渠兴乾, 王卫军. 右美托咪定复合超声引导下TAP阻滞麻醉对腹腔镜下腹股沟疝修补术病人Aβ-42、Tau蛋白的影响[J]. 蚌埠医学院学报, 2023, 48(3):344-348.
[14]	Gupta M, Liti B, Barrett C, et al. Prevention and management of hypertriglyceridemia-induced acute pancreatitis during pregnancy: A systematic review[J]. Am J Med, 2022, 135(6):709-714. doi: 10.1016/j.amjmed.2021.12.006 pmid: 35081380
[15]	闫文科, 宿华威. 超声引导下经皮腹腔穿刺置管引流术在重症急性胰腺炎治疗中的应用总结[J]. 肝胆胰外科杂志, 2020, 32(4):249-252.
[16]	Patel RP, McGill K, Motamedi D, et al. Ultrasound-guided interventions of the upper extremity joints[J]. Skeletal Radiol, 2023, 52(5):897-909.
[17]	孔德华, 孔宪刚, 王昆, 等. 多模式镇痛方案下超声引导腰方肌阻滞与腹横肌平面阻滞在剖宫产术后快速康复中的效果比较[J]. 国际麻醉学与复苏杂志, 2020, 41(7):672-677.
[18]	万香玉, 潘月帅, 姜金花, 等. 超声引导联合水气混合注射法在急性重症胰腺炎患者鼻肠管置入中的应用[J]. 中国中西医结合急救杂志, 2021, 38(5):570-573.
[19]	王磊, 原娜, 周莹, 等. 星状神经节阻滞对重症急性胰腺炎患者肺损伤的影响[J]. 中国现代医学杂志, 2020, 30(23):55-61.
[20]	高美玲, 王小梅. RDW、NLR、hs-CRP检测对急性胰腺炎严重程度的评估价值[J]. 临床荟萃, 2020, 35(8):724-726.
[21]	郁烨, 丁左缨, 周敏露. 清腑灌肠方中药保留灌肠结合硝黄塌渍方对重症急性胰腺炎患者中医证候评分及生化指标的影响[J]. 四川中医, 2022, 40(9):84-87.
[22]	刘风雨. 胰腺炎相关蛋白(PAP-I)通过激活脊髓小胶质细胞维持神经病理性疼痛[J]. 中国疼痛医学杂志, 2020, 26(1):9.
[23]	Cruciat G, Nemeti G, Goidescu I, et al. Hypertriglyceridemia triggered acute pancreatitis in pregnancy-diagnostic approach, management and follow-up care[J]. Lipids Health Dis, 2020, 19(1):2.
[24]	雷桂花, 吴小青, 项慧芬, 等. 老年急性胰腺炎继发脓毒症外周血单免疫球蛋白白细胞介素-1受体相关蛋白表达及意义[J]. 中华医院感染学杂志, 2023, 33(5):728-732.
[25]	Bhatt AA, Whaley DH, Lee CU. Ultrasound-guided breast biopsies: Basic and new techniques[J]. J Ultrasound Med, 2021, 40(7):1427-1443.