腹横筋膜阻滞联合舒芬太尼背景剂量优化在腹腔镜全子宫切除术中的应用效果

The Effect of Transversus Abdominis Plane Block Combined with Optimized Sufentanil Background Dose in Laparoscopic Total Hysterectomy

摘要: 目的：探讨不同背景剂量舒芬太尼联合腹横肌平面阻滞对腹腔镜全子宫切除术后镇痛效果及恢复质量的影响。方法：选取2023年10月至2025年4月拟行腹腔镜全子宫切除术的60例患者，根据随机数字表法将其分为两组，即无背景剂量组(O组)和背景剂量2 ml/h组(S组)，每组30例。两组患者术毕入恢复室后，在监护下实施超声引导下双侧腹横肌平面阻滞(TAP)，随后连接并开启镇痛泵。镇痛泵配方为舒芬太尼1.5 µg/kg加0.9%生理盐水配制为总量100 ml，O组为无背景剂量，单次给药4 ml，S组为背景剂量2 ml/h，单次给药2 ml。记录患者术后2 h、4 h、8 h、12 h、24 h静息及动态疼痛视觉模拟评分(VAS)；记录患者术前1 d、术后第1天、第3天和第5天的15项恢复质量评分；记录患者术后48h内病人自控静脉镇痛(PCIA)药物总用量及补救镇痛次数，并随访患者术后不良反应发生情况。结果：两组患者术后各时点静息及动态疼痛视觉模拟评分的比较，差异无统计学意义(P > 0.05)，O组术后第1天、第3天和第5天的15项恢复质量评分高于S组，差异有统计学意义(P < 0.05)，O组48 h内镇痛药物总用量及恶心呕吐发生率低于S组，差异有统计学意义(P < 0.05)。结论：腹横肌平面阻滞联合舒芬太尼无背景剂量或背景剂量2 ml/h PCIA模式均能满足腹腔镜全子宫切除患者术后镇痛需求，但与背景剂量2 ml/h相比，有效TAP阻滞联合无背景剂量、单次4 ml镇痛模式术后镇痛药物总用量明显减少，且恶心、呕吐发生率更低，患者术后恢复质量提高。

Abstract: Objective: To investigate the effects of different background doses of sufentanil combined with transversus abdominis plane block on postoperative analgesia and quality of recovery in patients undergoing laparoscopic total hysterectomy. Methods: Sixty patients scheduled for laparoscopic total hysterectomy from October 2023 to April 2025 were selected and randomly divided into two groups using a random number table: the no-background-dose group (Group O) and the background dose of 2 ml/h group (Group S), with 30 patients in each group. After surgery, upon admission to the recovery room, all patients underwent ultrasound-guided bilateral transversus abdominis plane block (TAP) under monitoring, followed by connection and activation of the analgesic pump. The analgesic pump consisted of sufentanil 1.5 μg/kg diluted with 0.9% normal saline to a total volume of 100 ml. Group O received no background dose with a bolus dose of 4 ml, while Group S received a background dose of 2 ml/h with a bolus dose of 2 ml. The resting and dynamic pain Visual Analogue Scale (VAS) scores were recorded at 2h, 4h, 8h, 12h, and 24h after surgery. The 15-item Quality of Recovery score (QoR-15) was recorded on the day before surgery and on postoperative days 1, 3, and 5. The total consumption of patient-controlled intravenous analgesia (PCIA) drugs and the number of rescue analgesia events within 48 hours after surgery were recorded, and the incidence of postoperative adverse reactions was followed up. Results: There was no statistically significant difference in resting and dynamic VAS scores between the two groups at various time points after surgery (P > 0.05). The QoR-15 scores of Group O on postoperative days 1, 3, and 5 were higher than those of Group S, with a statistically significant difference (P < 0.05). The total analgesic drug consumption within 48 hours and the incidence of nausea and vomiting in Group O were lower than those in Group S, with a statistically significant difference (P < 0.05). Conclusion: Both the no-background-dose mode (bolus 4 ml) and the background dose of 2 ml/h mode of sufentanil PCIA combined with TAP block could meet the postoperative analgesic needs of patients undergoing laparoscopic total hysterectomy. However, compared with the background dose of 2 ml/h mode, The total dosage of postoperative analgesic drugs was significantly reduced in the effective TAP block combined with no background dose and single 4ml analgesic mode, lowered the incidence of nausea and vomiting, and improved the quality of postoperative recovery.