系统化镇痛护理联合腹横筋膜平面阻滞对腹腔镜胃癌手术患者疼痛的影响及作用机制的探讨

Observation of the Effectiveness of Systemic Analgesia Combined With Transverse Abdominal Muscle Plane Blockade in Patients Undergoing Laparoscopic Gastric Cancer Surgery

摘要

本研究旨在探究系统化镇痛护理联合腹横筋膜平面阻滞(transversus abdominis plane block，TAPB)对腹腔镜胃癌手术患者疼痛的影响及作用机制，分析其对术后镇痛效果及护理干预质量的影响，提升术后康复效率和护理满意度. 研究选取 2024 年 1 月—2025 年 6 月某三级甲等肿瘤专科医院接受腹腔镜胃癌手术的 120 例患者作为研究对象，按照随机数字表法分为干预组和对照组，每组 60 例. 两组患者均行全麻下腹腔镜胃癌手术，对照组术后采用系统化镇痛护理，干预组在此基础上联合腹横筋膜平面阻滞技术. 比较两组患者的围术期指标、血流动力学、疼痛程度(视觉模拟评分法(visual analogue scale，VAS))、镇痛药物用量、首次下床时间、住院时间、不良反应发生率及护理满意度等指标. 干预组术后6h、12h、24h、48hVAS 评分显著低于对照组，差异具有统计学意义(P<0.05). 干预组术后镇痛药总用量明显低于对照组(P<0.05)，首次下床活动时间、住院时间均优于对照组(P<0.05). 与 T0 时点(术前)比较，两组患者在 T1(术中 10min)、T2(术中 30min)及 T3(术中 60min)时点的 HR 和 MAP 均显著降低，且干预组在 T1、T2、T3 时点的 HR 和 MAP 均高于对照组(P<0.05)，干预组护理满意度高于对照组(P<0.05)；不良反应发生率(恶心、镇静过度、呼吸抑制等)低于对照组(P<0.05). 腹腔镜胃癌手术患者采用系统化镇痛护理联合腹横筋膜平面阻滞可显著增强镇痛效果、减少镇痛药用量、缩短康复时间，并提升护理满意度与安全性，体现了良好的临床实用性和推广价值，值得在肿瘤专科护理中广泛应用.

Abstract

The study aims to investigate the clinical application value of systemic analgesia combined with transversus abdominis plane block(TAPB) in postoperative analgesia for patients undergoing laparoscopic gastric cancer surgery， analyze its impact on postoperative analgesic effects and the quality of nursing interventions，and enhance postoperative rehabilitation efficiency and nursing satisfaction. A total of 120 patients who underwent gastric cancer radical resection at a tertiary grade A oncology specialized hospital from January 2024 to June 2025 were selected as the research subjects. The participants were randomly divided into an observation group and a control group employed with the random number table method，with 60 cases in each group. All the participants underwent laparoscopic gastric cancer surgery under general anesthesia. The control group received a systemic analgesia after surgery，while the observation group was treated with transversus abdominis plane block technology in addition to the same regimen as the control group. Various indicators were compared between the two groups，including postoperative pain scores(visual analog scale，VAS)，the total dosage of analgesic drugs，the time to first ambulation，the length of hospital stay，the incidence of adverse reactions，and nursing satisfaction. The VAS scores of the observation group at 6h，12h，24h，and 48h after surgery were significantly lower than those of the control group，with statistically significant differences(P<0.05). The total postoperative analgesic dosage in the observation group was significantly lower than that in the control group(P<0.05). The time to first ambulation and the length of hospital stay in the observation group were better than those in the control group(P< 0. 05). The nursing satisfaction in the observation group was higher than that in the control group(P<0.05)，and the incidence of adverse reactions(such as nausea，excessive sedation，and respiratory depression) was lower than that in the control group(P< 0.05). The application of systemic analgesia combined with transversus abdominis plane block in anesthesia nursing after gastric cancer radical resection can significantly enhance the analgesic effect，reduce the dosage of analgesic drugs，shorten the rehabilitation time， and improve nursing satisfaction and safety. It demonstrates good clinical practicability and promotion value and is worthy of widespread application in oncology specialized nursing.

关键词

系统化镇痛 / 腹横筋膜平面阻滞 / 腹腔镜胃癌手术 / 术后镇痛

Key words

systemic analgesia / transversus abdominis plane block / laparoscopic gastric cancer surgery / postoperative analgesia

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基金资助

吴阶平医学基金会专项基金项目(320.6750.2022-18-50)