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摘要：
目的 观察腹横肌平面阻滞（transversus abdominis plane block, TAPB）应用于腹壁子宫内膜异位症（abdominal wall endometriosis, AWE）患者高强度聚集超声（high intensity focused ultrasound, HIFU）治疗的有效性和安全性。 方法 2020年1月—2020年12月在长沙市妇幼保健院行HIFU刀治疗的AWE患者80例，按随机数字表法分为两组：咪达唑仑+芬太尼静脉镇痛组（MF组）和腹横肌平面阻滞镇痛组（TAPB组），每组40例。MF组在常规监测下静脉注射芬太尼3 μg/kg、咪达唑仑30 μg/kg，1 h后手术未完成者追加芬太尼1 μg/kg、咪达唑仑10 μg/kg。TAPB组在HIFU治疗前0.25%罗哌卡因（20 ml）行双侧TAPB。记录两组患者入室前（T1）、治疗前（T2）、治疗后10 min（T3）、治疗后30 min（T4）、治疗后1 h（T5）、治疗后2 h（T6）的MAP、心率、SpO2、呼吸频率（respiratory frequency, RR），记录两组患者T3、T4、T5、T6时的麻醉后恢复改良（Modified Aldrete Score, Aldrete）评分，记录两组患者PACU停留时间、围手术期VAS疼痛评分及术后恶心呕吐（postoperative nausea and vomiting, PONV）次数，并于患者出院后1 d进行满意度问卷调查。 结果 T3时MF组心率、MAP、RR高于TAPB组（P<0.05），T4时MF组MAP高于TAPB组（P<0.05）。T3、T4、T5时MF组意识评分低于TAPB组（P<0.05）。TAPB组患者术后PONV次数及VAS疼痛评分低于MF组（P<0.05），PACU停留时间短于MF组（P<0.05），患者满意度评分高于MF组（P<0.05）。其余指标两组差异无统计学意义（P>0.05）。 结论 在AWE HIFU刀治疗中应用TAPB镇痛的患者满意度更高，有效性和安全性更优。
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Abstract: Objective To observe the effectiveness and safety of transversus abdominis plane block (TAPB) in the treatment of patients with abdominal wall endometriosis (AWE) using high intensity focused ultrasound (HIFU). Methods A total of 80 AWE patients who were treated by HIFU knife in Changsha Hospital for Maternal and Child Health Care from January 2020 to December 2020 were enrolled. According to the random number table method, they were divided into two groups (n=40): a dazolam combined with fentanyl intravenous anesthesia group (group MF) and a transverse abdominal muscle plane block group (group TAPB). Under routine monitoring, in group MF intravenous fentanyl 3 μg/kg and midazolam 30 μg/kg was injected, if the operation is not completed in 1 h, intravenous fentanyl 1 μg/kg and midazolam 10 μg/kg shall be added. In group TAPB, bilateral TAPB was performed with 0.25% ropivacaine (20 ml) before HIFU knife treatment. Both groups were compared for mean artery pressure (MAP), heart rate, oxygen saturation (SpO2), and respiratory frequency (RR) before entering the room (T1), before treatment (T2), and 10 min after treatment (T3), 30 min after treatment (T4), 1 h after treatment (T5), and 2 h after treatment (T6). Their post‑anesthesia recovery improvement (the Modified Aldrete Score) at T3, T4, T5 and T6, while their perioperative VAS score, postoperative nausea and vomiting (PONV) and the length of postanesthesia care unit (PACU) stay were recorded. Evaluate the satisfaction of discharged patients by telephone on the next day. Results The HR, MAP and RR in the group MF were higher than those in the group TAPB at T3 (P<0.05). The MAP in the group MF was higher than that in the group TAPB at T4 (P<0.05). The Aldrete score of the group MF was lower than that of the group TAPB at T3, T4, and T5 (P<0.05). Compared with the group MF, the group TAPB presented decreases in the number of PONV and VAS score (P<0.05), as well as decrease in the length of PACU stay (P<0.05), and increased satisfaction scores (P<0.05). There was no statistical difference in other indicators (P>0.05). Conclusions TAPB can be applied in the treatment of AWE patients with HIFU knife, with higher satisfaction, and better effectiveness and safety.
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