目的 探讨超声引导下腹横肌平面(Transversus abdominis plane, TAP)阻滞在急性胰腺炎中的应用及对腹痛、胰腺炎相关蛋白(Pancreatitis-associated protein,PAP)水平的影响。方法 选取2019年7月-2023年8月我院收治的急性胰腺炎患者95例,按照随机数表法分成2组,即对照组47例,试验组 48例。对照组给予静脉注入舒芬太尼镇痛,试验组给予超声引导下TAP阻滞镇痛。比较两组镇痛后生命体征、腹痛发生率、PAP阳性率、疼痛、镇静评分、淀粉酶、脂肪酶、尿淀粉酶、系统急性生理学及慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHEⅡ)、改良多脏器功能障碍(multiple organ dysfunction score,Marshall)评分变化情况。结果 两组镇痛后体温比较差异无统计学意义(P>0.05);试验组心率、呼吸频率低于对照组,氧合指数高于对照组(P<0.05);镇痛后,试验组腹痛发生率及PAP阳性率低于对照组(P<0.05);镇痛后,两组疼痛、镇静评分均降低,且试验组降低更显著(P<0.05);镇痛后,两组淀粉酶、脂肪酶及尿淀粉酶均降低,且试验组降低更显著(P<0.05);镇痛后,两组APACHEⅡ、Marshall评分均降低,且试验组降低更显著(P<0.05)。结论 超声引导下TAP阻滞在急性胰腺炎镇痛中有一定的效果,可有效改善患者腹痛、PAP水平。

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.