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摘要：
目的 探讨单次腹横肌平面阻滞（transversus abdominis plane block, TAPB）联合患者自控静脉镇痛（patient⁃controlled intravenous analgesia, PCIA）用于强直性脊柱炎（ankylosing spondylitis, AS）截骨矫形手术术后镇痛的效果。 方法 40例行截骨矫形手术的AS患者，采用数字随机法分为2组（每组20例）：TAPB联合PCIA组（T组）和单纯PCIA组（P组）。P组患者手术结束采用单纯PCIA镇痛，T组患者在P组基础上联合单次TAPB进行镇痛。观察两组患者术后2 h（T1）、6 h（T2）、12 h（T3）、24 h（T4）、48 h（T5）的VAS疼痛评分，术后24 h内PCIA按压情况及镇痛药物追加情况；记录两组患者术后24 h不良反应发生情况；记录两组患者术前和术后1 d焦虑自评量表（Self⁃Rating Anxiety Scale, SAS）和抑郁自评量表（Self⁃Rating Depression Scale, SDS）评分。 结果 T组患者术后T1、T2、T3、T4、T5的VAS疼痛评分低于P组（P<0.05）；T组患者术后24 h内PCIA按压比例低于P组（P<0.05）；T组患者术后追加镇痛药物使用比例低于P组（P<0.05）；手术前两组患者的SAS和SDS评分差异无统计学意义（P>0.05），术后1 d P组患者的SAS和SDS评分较术前上升（P<0.05），术后1 d T组患者SAS、SDS评分均低于P组（P<0.05）；两组患者术后并发症发生率差异无统计学意义（P>0.05）。 结论 单次TAPB联合PCIA可安全应用于截骨矫形手术AS患者，减轻术后疼痛，缓解术后焦虑抑郁情绪，有利患者康复。
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Abstract: Objective To observe the clinical effectiveness of single transversus abdominis plane block (TAPB) combined with patient‑controlled intravenous analgesia (PCIA) for postoperative analgesia in ankylosing spondylitis (AS) patients treated with pedicle subtraction osteotomy. Methods A total of 40 AS patients undergoing pedicle subtraction osteotomy were selected. According to the random number table method, they were divided into two groups (n=20): a TAPB combined with PCIA group (group T) and a PCIA group (group P). Group P was given postoperative PCIA alone，while group T received simply TAPB combined with postoperative PCIA. Their Visual Analogue Scale (VAS) scores were recorded in both groups 2 h after surgery (T1), 6 h after surgery (T2), 12 h after surgery (T3), and 24 h after surgery (T4). The effective pressing times of PCIA and the use of rescue analgesia 24 h after surgery were recorded. The incidences of adverse reactions were also recorded in both groups 24 h after surgery. The scores of Self⁃Rating Anxiety Scale (SAS) and Self⁃Rating Depression Scale (SDS) were evaluated in both groups before surgery and 1 day after surgery were recorded. Results Patients in group T presented remarkably lower VAS scores than those in group P at T1, T2, T3, T4, and T5 (P<0.05). Patients in group T showed a significantly reduced percentage of pressing PCIA 24 h after surgery, compared with group P (P<0.05). Patients in group T showed a significantly reduced percentage of rescue analgesia, compared with group P (P<0.05). Before surgery, there was no significant difference in SAS and SDS scores between the two groups (P>0.05). One day after surgery, the SAS and SDS scores of patients in group P increased compared with those before surgery (P<0.05). One day after surgery, the scores of SAS and SDS in group T were lower than those in group P (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusions The combination of simple TAPB and PCIA can be safely applied in pedicle subtraction osteotomy for AS patients, which weakens postoperative pain, relieves anxiety and depression after surgery, and fastens recovery.
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